Medial joint line bone bruising at MRI complicating acute ankle inversion injury: What is its clinical significance? 10. Surgical treatment methods for chronic injury of the distal tibiofibular syndesmosis include debridement, arthrodesis, screw fixation, suture-button repair, and graft reconstruction [7, 8]. The distal osseous part of this syndesmotic joint … PURPOSE: To compare the use of magnetic resonance (MR) imaging with the use of arthroscopy for the diagnosis of tibiofibular syndesmotic injury. The κ value regarding injury of the anterior syndesmosis was moderate (κ = 0.48) for the axial plane and very good (κ = 0.81) for the oblique plane, although the AS for both planes was good (84 and 86%, respectively). Some tibiofibular overlap was present in all radiographs in any position of rotation. Furthermore our study shows the combined measurement of medial clear space and superior clear space to be useful, as the medial clear space should not exceed the superior clear space in any projection of the nonweightbearing ankle. 4, No. Syndesmotic injury usually occurred in ankle sprain with external rotation of the talus that resulted at either ligamentous rupture or bony avulsion of the syndesmotic ligament complex. Injury of the distal Tibiofibular Syndesmosis of the Ankle:Assesment with contrast enhanced 3D-FSPGR MR imaging S. Kim 1 , Y-M. Huh 2 , H-T. Song , J-S. Archives of Orthopaedic and Trauma Surgery, Techniques in Foot & Ankle Surgery, Vol. Lippincott Journals Subscribers, use your username or email along with your password to log in. To determine mean and range, 8640 readings were made for six of the parameters, and 960 each for medial clear space and superior clear space, as the latter two could not be measured in extreme internal and external rotation. This resulted from the inability to reproduce ankle positioning, even under optimal laboratory circumstances. Unilateral absence of tibiofibular overlap should raise the suspicion of a syndesmotic injury, and a medial clear space exceeding the superior clear space on a nonweightbearing radiograph should raise the suspicion of deltoid ligament injury in any projection of a normal ankle. 105, No. 28, No. Further articles were derived from the references of the primary articles. In twisting injuries of the ankle which result in a high fibular fracture (Lauge-Hansen pronation external rotation injuries) there is a disruption of the syndesmosis. 2, American Journal of Roentgenology, Vol. Von Hagens G, Tiedemann K, Kriz W: The current potential of plastination. Enter your email address below and we will send you the reset instructions. The reported incidence of isolated syndesmosis injuries in acute ankle sprains ranges between 1% and 16%. External rotation of the talus has been identified as the major mechanism of syndesmotic injury. 4, Journal of Orthopaedic Surgery, Vol. 1, Techniques in Foot & Ankle Surgery, Vol. Injuries of the distal tibiofibular syndesmosis occur either isolated, or in combination with ankle fractures. Boden et al15 transected the syndesmosis, then sequentially di-vided the interosseous membrane in 1.5-cm increments in two groups of 800-638-3030 (within the USA), 301-223-2300 (outside of the USA). 3, 15 November 2014 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 4, Journal of Bone and Joint Surgery, Vol. (2010) 217, pp633-645. J Anat 217:633–645 Article Google Scholar 10. 33, No. 1,2 Patients with ankle injuries with concomitant syndesmotic disruption have more pain and poorer function 1 year post-injury than those with ankle fractures without syndesmotic injury. 24, No. The distances between the floor of the incisura fibularis and the posterior tibial tubercle and between the floor of the incisura fibularis and the anterior tibial tubercle showed similar trends. J Bone Joint Surg 59A:874–877, 1977. 4, Journal of Orthopaedic Trauma, Vol. 6, 2 May 2013 | Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, Vol. 3, Magnetic Resonance Imaging Clinics of North America, Vol. A singular procedure involving both a distal tibiofibular synostosis resection with syndesmosis repair by peroneus longus ligamentoplasty has not been reported in the English literature. 6. If there were no replicate positionings per ankle, the positioning component was added and therefore was included in the ankle component whereas the total variance did not change. Each of these sources was a certain proportion of the total variance, and together they added up to the total variance of the readings. 2012 Jun;36(6):1199-206. doi: 10.1007/s00264-012-1500-2. 4, No. 4, 28 June 2016 | Foot & Ankle International, Vol. 1, 16 August 2013 | Current Reviews in Musculoskeletal Medicine, Vol. On the mortise view the width of the fibula was the only parameter that could be measured reliably. MRI, as standard of reference, was performed to evaluate the integrity of the distal tibiofibular syndesmosis. 15, No. This caused the ankle component in the total variance to become too great and reproducibility too small. 4, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. Joy G, Patzakis MJ, Harvey Jr JP: Precise evaluation of the reduction of severe ankle fractures. A careful evaluation of the distal tibiofibular relationship with regard to the medial clear space, the tibiofibular clear space, and the tibiofibular overlap is crucial ( 16 , 17 and 18 ). Instr Course Lect 24:251–293, 1975. 47, No. 8. Unfortunately, the range per position was too great to consider this distance a useful parameter. Some error has occurred while processing your request. Search terms used were: syndesmosis paired with injury, imaging, radiology, X‐ray, stress X‐ray, arthrography, ultrasound, nuclear medicine scan, CT scan, MRI and arthroscopy. Injury to the distal tibiofibular syndesmosis has a significant association with a number of secondary findings on MRI, including anterior talofibular ligament injury, bone bruises, osteochondral lesions, tibiofibular joint congruity, and height of the tibiofibular recess. Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, June 2004 - Volume 423 - Issue - p 227-234, Radiographic Measurement of the Distal Tibiofibular Syndesmosis Has Limited Use, Articles in Google Scholar by A Beumer, MD, Other articles in this journal by A Beumer, MD. 6, 1 June 2017 | American Journal of Roentgenology, 13 July 2017 | Trauma und Berufskrankheit, Vol. 24, No. 5, Clinical Orthopaedics and Related Research, Vol. Radiology 2003; 227:155. Brage et al1 showed excellent reliability for certain parameters measured on ankle radiographs, with reliability increasing with experience. Our objective was to describe the MRI findings associated with acute and chronic distal tibiofibular syndesmosis injury. J. Anat. Those authors however, did not address interobserver reliability and repeated ankle radiography. Tibiofibular overlap and medial and superior clear space are the most useful, because one-sided traumatic absence of tibiofibular overlap may be an indication of syndesmotic injury, and a medial clear space larger than a superior clear space is indicative of deltoid injury. Based on our observations, it is evident that no optimal radiographic parameter exists to assess syndesmotic integrity, because all parameters are dependent on the position of rotation. The absolute values of medial clear space and superior clear space changed considerably in the different positions of rotation. 51, No. 5, American Journal of Roentgenology, Vol. Lateral ligament sprains are undoubtedly the most frequent (85%) type of ankle sprain, accompanied by medial 'deltoid' ligament sprains and more infrequent is injury to the distal tibiofibular syndesmosis… 4, © 2021 Radiological Society of North America, Injury of the Tibiofibular Syndesmosis: Value of MR Imaging for Diagnosis, https://doi.org/10.1148/radiol.2271011865, Arthroscopic Grading of Injuries of the Inferior Tibiofibular Syndesmosis, Imaging in syndesmotic injury: a systematic literature review, ACR Appropriateness Criteria ® Chronic Ankle Pain, Diagnostic imaging of ankle syndesmosis injuries: A general review, The predictive value of MRI in the syndesmotic instability of ankle fracture, The effect of ankle distraction on arthroscopic evaluation of syndesmotic instability: A cadaveric study, A Radiographic Dye Method for Intraoperative Evaluation of Syndesmotic Injuries, Effect of Sequential Sectioning of Ligaments on Syndesmotic Instability in the Coronal Plane Evaluated Arthroscopically, Arthroscopic Deltoid Repair: A Technical Tip, Acute syndesmotic instability in ankle fractures: A review, Management of syndesmotic injuries of the ankle, Intraoperative 3‑D-Röntgenkontrolle bei Verletzungen des Fußes und des Sprunggelenks, Arthroscopic Correlates of Subtle Syndesmotic Injury, Comprehensive Assessment of Ankle Syndesmosis Injury Using 3D Isotropic Turbo Spin-Echo Sequences: Diagnostic Performance Compared With That of Conventional and Oblique 3-T MRI, Isolated Syndesmosis Diastasis: Computed Tomography Scan Assessment With Arthroscopic Correlation. Injuries can occur to one or more of the structures that make up the distal syndesmosis1: 1. 6, 20 October 2011 | Skeletal Radiology, Vol. For more information, please refer to our Privacy Policy. reported a sensitivity of 100%, a specificity of 93%, and an accuracy of 97% in diagnosing a syndesmosis injury with MRI. 12, 8 September 2017 | Foot & Ankle International, Vol. Reconstruction of the distal tibiofibular syndesmosis with an autogenous tendon graft in these patients is effective, although relatively rarely reported. All patients were examined with MR imaging for diagnosis of tibiofibular syndesmotic injury. 37, No. 7, Orthopaedic Journal of Sports Medicine, Vol. The distal tibiofibular syndesmosis consists of Three observations important for clinical practice were made. 15, No. may email you for journal alerts and information, but is committed 1984;66(4):490–503. 83, No. Reproducibility measures the maximum absolute difference between two replicate readings (taken under reproducible conditions) that can be attributed to chance with 95% probability, (the maximum absolute difference that is exceeded with a probability of 5%). Additional quantitative measurement of all syndesmotic parameters with repeated radiographs of the ankle cannot be done reliably and therefore are of little value. MATERIALS AND METHODS. 8, The Journal of Foot and Ankle Surgery, Vol. 7, No. Lippincott Journals Subscribers please login with your username or email along with your password. If the syndesmosis is completely disrupted, diastasis can be seen on plain AP ankle or mortise radiographs. Tibiofibular syndesmotic injuries often occur as a consequence of an Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Harper MC, Keller TS: A radiographic evaluation of the tibiofibular syndesmosis. Each specimen was mounted on a testing device that allowed full rotation of the leg around its longitudinal axis, while the ankle was kept in a slightly plantar flexed position comparable to common clinical practice, and to avoid widening of the mortise caused by forced dorsiflexion. PURPOSE To compare the use of magnetic resonance (MR) imaging with the use of arthroscopy for the diagnosis of tibiofibular syndesmotic injury. For immediate assistance, contact Customer Service: However, bilateral nontraumatic absence of tibiofibular overlap can be seen in some people. 2, Clinics in Sports Medicine, Vol. Chronic injuries of the distal tibiofibular syndesmosis are common in patients who fail to receive adequate diagnosis and timely treatment. First the overlap of the fibula with the tibia with respect to either the anterior (the distance between the medial side of the fibula and the anterior tibial tubercle) or the posterior tibial tubercle (the distance between the medial side of the fibula and the posterior tibial tubercle) was positive or 0 in every radiograph. MRI allows an accurate picture of ligamentous anatomy and the distal tibiofibular joint. 7. This study shows that no optimal radiographic parameter exists to assess syndesmotic integrity. 2, Journal of Bone and Joint Surgery, Vol. Introduction to Lauge Hansen & Danis Weber Classifications Ankle Fracture Author information: (1)Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 6, Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine, Russian Journal of Pediatric Surgery, Vol. 28, No. Syndesmotic injury may occur solely as a soft-tissue injury or in association with ankle fracture. Injury to the distal tibiofibular syndesmosis can occur after an ankle sprain or after an acute ankle fracture. This was confirmed with the calculation of more realistic intraclass correlation coefficients and reproducibility based on the replicate positioning. The tibiofibular clear space (TFCS) is a radiographic measure and defined as the space between the groove of the distal tibial prominence and the medial margin of the distal fibula 1-3. 2000; 71(5):519–521. Tibiofibular overlap of either the anterior or the posterior tubercle and the fibula was positive or 0 in every radiograph. The intraclass correlation coefficient is defined as the between-ankle variance (ankle component) as a proportion of the total variance, therefore it is a dimensionless number between 0 and 1 (the nearer to 1, the better). This multiple (replicate) positioning increased the total amount of readings to 15,360. 105, No. Yuen CP(1), Lui TH(2). Plastination does not change macroscopic or microscopic anatomy, so results from this study should be comparable to results of unloaded ankle radiographs in the clinical setting. Sclafani SJ: Ligamentous injury of the lower tibiofibular syndesmosis: Radiographic evidence. 3, Physical Therapy in Sport, Vol. When an MR imaging diagnosis was based on criteria 1 and 2, the diagnosis of AITFL disruption was made with a sensitivity of 100%, a specificity of 93%, and an accuracy of 97%, whereas the diagnosis of PITFL disruption was made with a sensitivity of 100%, a specificity of 100%, and an accuracy of 100%. 18, No. Author information: (1)Department of Radiology, Humboldt-University of Berlin, Germany. For distal tibiofibular syndesmosis, its chief function is to maintain the congruency of the tibiotalar interface under physiologic axial loads. Injuries of the distal tibiofibular syndesmosis occur either isolated, or in combination with ankle fractures. Arthroscopic findings and results of anatomical reconstruction, Vorteile der intraoperativen 3D-Bildgebung, Evaluation and management of ankle syndesmosis injuries, Rehabilitation of Syndesmotic (High) Ankle Sprains, Delayed operative treatment of syndesmotic instability. In twisting injuries of the ankle which result in a high fibular fracture (Lauge-Hansen pronation external rotation injuries) there is a disruption of the syndesmosis. 62, No. 41, No. 9, Revue de Chirurgie Orthopédique et Traumatologique, Vol. Injury of the anterior or posterior distal tibiofibular syndesmosis can be either a rupture of the distal tibiofibular ligament or a bony avulsion from either the fibula or tibia. 5, 31 March 2009 | The American Journal of Sports Medicine, Vol. 4, Journal of Medical Imaging and Radiation Oncology, Vol. Late reconstruction of the anterior distal tibiofibular syndesmosis: good outcome in 9 patients. Radiology 175:21–27, 1985. [email protected]. 36, No. 41, No. 14, No. Please try after some time. Computed tomography scans can show the tibial tubercles the incisura fibularis and tibiofibula, as has been shown in cadaveric studies describing the normal aspect of the incisura fibularis,2,5 but criteria how to distinguish the normal from the injured syndesmosis with CT have not been described, and reproducibility of CT for this purpose has not been assessed. A syndesmosis is defined as a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments. When ankle disability lasts for more … 11, Current Sports Medicine Reports, Vol. British volume, Vol. It has the same dimension (mm) as the readings and can be interpreted clinically (the smaller, the better). The syndesmosis joint consists of a fibrous link between the distal tibia and fibula (end of the shin bones) (Hermans et al., 2010). However it is a poorly recognized injury and often missed. When MR imaging revealed ligament discontinuity (criterion 1) or either a wavy or curved ligament contour or nonvisualization of the ligament (criterion 2), the injury was considered to be a ligament disruption. 57, No. MRI of Isolated Distal Fibular Fractures with Widened Medial Clear Space on Stressed Radiographs: Which Ligaments Are Interrupted? 9, Orthopaedics & Traumatology: Surgery & Research, Vol. 4, Journal of Orthopaedic Trauma, Vol. MATERIALS AND METHODS This study involved 58 patients who had ankle sprains or distal fibular fractures and underwent surgery. Objective: Our objective was to describe the MRI findings associated with acute and chronic distal tibiofibular syndesmosis injury. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. The tibiofibular syndesmosis is a complex fibrous joint composed of multiple ligaments and a broad fibrous interosseous membrane that spans between the tibia and fibula throughout the length of both bones. sup327, Journal of the Korean Fracture Society, Vol. 4, 24 December 2015 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair Int Orthop . Arthroscopic Quantification of Syndesmotic Instability in a Cadaveric Model, Football Ankle Fractures and Return to Sport: A Review on the Arthroscopic Approach, Möglichkeiten der funktionellen sonografischen Diagnostik bei der Primärbehandlung fibularer Kapsel-Band-Verletzungen des Sprunggelenks, Magnetic resonance imaging characterization of individual ankle syndesmosis structures in asymptomatic and surgically treated cohorts, Stable and unstable grade II syndesmotic injuries require different treatment strategies and vary in functional outcomes: a systematic review, Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines, Stable Versus Unstable Grade II High Ankle Sprains: A Prospective Study Predicting the Need for Surgical Stabilization and Time to Return to Sports, A rare type of ankle fracture: Syndesmotic rupture combined with a high fibular fracture without medial injury, Sports Medicine of the Foot & Ankle, the Role of Imaging, Acute and Chronic Injuries to the Syndesmosis, Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures, Analysis of PITFL Injuries in Rotationally Unstable Ankle Fractures, Diagnostic accuracy of clinical tests for ankle syndesmosis injury, Traitement de l'instabilité chronique et isolée de la syndesmose tibiofibulaire distale, Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3T MRI, Evaluation and management of injuries of the tibiofibular syndesmosis, Ligamentous Injuries and the Risk of Associated Tissue Damage in Acute Ankle Sprains in Athletes, Clinical Orthopedic Examination Findings in the Lower Extremity: Correlation with Imaging Studies and Diagnostic Efficacy, Post-traumatic heterotopic ossification of distal tibiofibular syndesmosis mimicking a surface osteosarcoma, Standardization of the functional syndesmosis widening by dynamic U.S examination, Isolated Posterior High Ankle Sprain: A Report of Three Cases.
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