Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability
Category: Ankle Introduction/Purpose: Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P- US with progressive stag...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-11-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011421S00683 |
| _version_ | 1811230731497635840 |
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| author | Noortje Hagemeijer MD Bart Lubberts MD, PhD Jirawat Saengsin MD Rohan Bhimani MD, MBA Go Sato MD Gregory R. Waryasz MD Gino Kerkhoffs MD Christopher W. DiGiovanni MD Daniel Guss MD, MBA |
| author_facet | Noortje Hagemeijer MD Bart Lubberts MD, PhD Jirawat Saengsin MD Rohan Bhimani MD, MBA Go Sato MD Gregory R. Waryasz MD Gino Kerkhoffs MD Christopher W. DiGiovanni MD Daniel Guss MD, MBA |
| author_sort | Noortje Hagemeijer MD |
| collection | DOAJ |
| description | Category: Ankle Introduction/Purpose: Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P- US with progressive stages of syndesmotic ligamentous transection. Methods: Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the 1) anterior-inferior tibiofibular ligament (AITFL), 2) interosseous ligament (IOL), and 3) posterior-inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5 Nm, 6.0 Nm, 7.5 Nm, and 9.0 Nm of external rotation stress at each stage of ligamentous transection stage using both P-US and fluoroscopy. Results: When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 +- 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P- US and fluoroscopy. Conclusion: P-US is much more sensitive than fluoroscopy in diagnosing syndesmotic instability during external rotation stress examination. Extrapolated to the clinical setting, 4.5 Nm of force can be used when comparing to the stressed, uninjured side, and may be better tolerated by patients than higher torque values. When using P-US, a TFCS-opening of 2.6 mm is likely to correlate with syndesmotic instability. While absolute threshold values may vary between individuals, the ready availability of the contralateral, uninjured side overcomes this constraint. |
| first_indexed | 2024-04-12T10:33:55Z |
| format | Article |
| id | doaj.art-af6d194b59884a3eb7eb2c61b5086017 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-12T10:33:55Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-af6d194b59884a3eb7eb2c61b50860172022-12-22T03:36:47ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142022-11-01710.1177/2473011421S00683Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic InstabilityNoortje Hagemeijer MDBart Lubberts MD, PhDJirawat Saengsin MDRohan Bhimani MD, MBAGo Sato MDGregory R. Waryasz MDGino Kerkhoffs MDChristopher W. DiGiovanni MDDaniel Guss MD, MBACategory: Ankle Introduction/Purpose: Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P- US with progressive stages of syndesmotic ligamentous transection. Methods: Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the 1) anterior-inferior tibiofibular ligament (AITFL), 2) interosseous ligament (IOL), and 3) posterior-inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5 Nm, 6.0 Nm, 7.5 Nm, and 9.0 Nm of external rotation stress at each stage of ligamentous transection stage using both P-US and fluoroscopy. Results: When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 +- 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P- US and fluoroscopy. Conclusion: P-US is much more sensitive than fluoroscopy in diagnosing syndesmotic instability during external rotation stress examination. Extrapolated to the clinical setting, 4.5 Nm of force can be used when comparing to the stressed, uninjured side, and may be better tolerated by patients than higher torque values. When using P-US, a TFCS-opening of 2.6 mm is likely to correlate with syndesmotic instability. While absolute threshold values may vary between individuals, the ready availability of the contralateral, uninjured side overcomes this constraint.https://doi.org/10.1177/2473011421S00683 |
| spellingShingle | Noortje Hagemeijer MD Bart Lubberts MD, PhD Jirawat Saengsin MD Rohan Bhimani MD, MBA Go Sato MD Gregory R. Waryasz MD Gino Kerkhoffs MD Christopher W. DiGiovanni MD Daniel Guss MD, MBA Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability Foot & Ankle Orthopaedics |
| title | Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability |
| title_full | Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability |
| title_fullStr | Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability |
| title_full_unstemmed | Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability |
| title_short | Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspected Syndesmotic Instability |
| title_sort | portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability |
| url | https://doi.org/10.1177/2473011421S00683 |
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