Do Coronal or Sagittal Plane Measurements Have the Highest Accuracy to Arthroscopically Diagnose Syndesmotic Instability?

2021 ◽  
pp. 107110072110041
Author(s):  
Rohan Bhimani ◽  
Bart Lubberts ◽  
Pongpanot Sornsakrin ◽  
Jafet Massri-Pugin ◽  
Gregory Waryasz ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Sagittal Plane ◽  
Area Under The Curve ◽  
Coronal Plane ◽  
Deltoid Ligament ◽  
Roc Curve Analysis ◽  
Level Of Evidence ◽  
Interosseous Ligament ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament

Background: To compare the accuracy of arthroscopic sagittal versus coronal plane distal tibiofibular motion toward diagnosing syndesmotic instability. Methods: Arthroscopic assessment of the syndesmosis was performed on 21 above-knee cadaveric specimens, first with all ligaments intact and subsequently with sequential transection of the anterior inferior tibiofibular ligament, the interosseous ligament, the posterior inferior tibiofibular ligament, and the deltoid ligament. A lateral hook test, an anterior-to-posterior (AP) translation test, and a posterior-to-anterior (PA) translation test were performed under 100 N of applied force. Anterior and posterior third coronal plane diastasis and AP and PA sagittal plane fibular translations were measured relative to the static tibia. Results: Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was higher for the combined AP and PA sagittal measurements (AUC, 0.91; accuracy, 83.5%; sensitivity, 78%; specificity, 89%) than the coronal plane measurements (anterior third: AUC, 0.65; accuracy, 60.5%; sensitivity, 63%; specificity, 59%; posterior third: AUC, 0.73; accuracy, 68.5%; sensitivity, 80%; specificity, 57%) ( P < .001), underscoring the higher accuracy of sagittal plane measurements. Conclusion: Arthroscopic measurement of sagittal plane fibular translation is more accurate than coronal plane diastasis for evaluating syndesmotic instability. Clinical Relevance: Clinicians should focus on distal tibiofibular motion in the sagittal plane when arthroscopically evaluating suspected syndesmotic instability. Level of Evidence: Biomechanical cadaveric study.

Role of the Deltoid Ligament in Syndesmotic Instability

2018 ◽  
Vol 39 (5) ◽  
pp. 598-603 ◽  
Author(s):  
Jafet Massri-Pugin ◽  
Bart Lubberts ◽  
Bryan G. Vopat ◽  
Jonathon C. Wolf ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Lateral Force ◽  
Coronal Plane ◽  
Deltoid Ligament ◽  
Lateral Stress ◽  
Interosseous Ligament ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Cadaveric Model

Background: The deltoid ligament (DL) is the principal ligamentous stabilizer of the medial ankle joint. Little is known, however, about the contribution of the DL toward stabilizing the syndesmosis. The aim of this study was to arthroscopically evaluate whether the DL contributes to syndesmotic stability in the coronal plane. Methods: Eight above-knee cadaveric specimens were used in this study. A lateral hook test was performed by applying 100 N of lateral force to the fibula in the intact state and after sequential transection of the DL, anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL). At each stage, distal tibiofibular diastasis was measured arthroscopically at both the anterior and posterior third of the incisura and compared to stress measurements of the intact syndesmosis. Measurements were performed using probes ranging from 0.1 to 6.0 mm, with 0.1-mm increments. Results: There was no significant increase in diastasis at either the anterior or posterior third of the tibiofibular articulation after isolated DL disruption, nor when combined with AITFL transection. In contrast, a significant increase in diastasis was observed following additional disruption of the IOL (anterior and posterior third diastasis, P= .012 and .026, respectively), and after transection of all 3 syndesmotic ligaments (anterior and posterior third diastasis, P=.001 and .001, respectively). Conclusion: When evaluating the syndesmosis arthroscopically in a cadaveric model under lateral stress, neither isolated disruption of the DL nor combined DL and AITFL injuries destabilized the syndesmosis in the coronal plane. In contrast, the syndesmosis became unstable if the DL was injured in conjunction with partial syndesmotic disruption that included the AITFL and IOL. Clinical relevance: Disruption of the DL appeared to destabilize the syndesmosis in the coronal plane when associated with partial disruption of the syndesmosis (AITFL and IOL).

Arthroscopic Assessment of Syndesmotic Instability in the Sagittal Plane in a Cadaveric Model

2019 ◽  
Vol 41 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Bart Lubberts ◽  
Jafet Massri-Pugin ◽  
Daniel Guss ◽  
Jonathon C. Wolf ◽  
Rohan Bhimani ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Cutoff Point ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Optimal Cutoff ◽  
Distal Fibula ◽  
Interosseous Ligament ◽  
Tibiofibular Ligament ◽  
Optimal Cutoff Point ◽  
Cadaveric Model

Background: Syndesmotic instability is multidirectional, occurring in the coronal, sagittal, and rotational planes. Despite the multitude of studies examining such instability in the coronal plane, other studies have highlighted that syndesmotic instability may instead be more evident in the sagittal plane. The aim of this study was to arthroscopically assess the degree of syndesmotic ligamentous injury necessary to precipitate fibular translation in the sagittal plane. Methods: Twenty-one above-knee cadaveric specimens underwent arthroscopic evaluation of the syndesmosis, first with all syndesmotic and ankle ligaments intact and subsequently with sequential sectioning of the anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL), the posterior inferior tibiofibular ligament (PITFL), and deltoid ligament (DL). In all scenarios, an anterior to posterior (AP) and a posterior to anterior (PA) fibular translation test were performed under a 100-N applied force. AP and PA sagittal plane translation of the distal fibula relative to the fixed tibial incisura was arthroscopically measured. Results: Compared with the intact ligamentous state, there was no difference in sagittal fibular translation when only 1 or 2 ligaments were transected. After transection of all the syndesmotic ligaments (AITFL, IOL, and PITFL) or after partial transection of the syndesmotic ligaments (AITFL, IOL) alongside the DL, fibular translation in the sagittal plane significantly increased as compared with the intact state ( P values ranging from .041 to <.001). The optimal cutoff point to distinguish stable from unstable injuries was equal to 2 mm of fibular translation for the total sum of AP and PA translation (sensitivity 77.5%; specificity 88.9%). Conclusion: Syndesmotic instability appears in the sagittal plane after injury to all 3 syndesmotic ligaments or after partial syndesmotic injury with concomitant deltoid ligament injury in this cadaveric model. The optimal cutoff point to arthroscopically distinguish stable from unstable injuries was 2 mm of total fibular translation. Clinical Relevance: These data can help surgeons arthroscopically distinguish between stable syndesmotic injuries and unstable ones that require syndesmotic stabilization.

scholarly journals Identification of an optimal prolactin threshold to determine prolactinoma size using receiver operating characteristic analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bianca M. Leca ◽  
Maria Mytilinaiou ◽  
Marina Tsoli ◽  
Andreea Epure ◽  
Simon J. B. Aylwin ◽  
...  
Keyword(s):  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Tumour Size ◽  
Area Under The Curve ◽  
Serum Prolactin ◽  
Pituitary Neoplasms ◽  
Characteristic Analysis ◽  
Roc Curve Analysis ◽  
Baseline Serum ◽  
Receiver Operating

AbstractProlactinomas represent the most common type of secretory pituitary neoplasms, with a therapeutic management that varies considerably based on tumour size and degree of hyperprolactinemia. The aim of the current study was to evaluate the relationship between serum prolactin (PRL) concentrations and prolactinoma size, and to determine a cut-off PRL value that could differentiate micro- from macro-prolactinomas. A retrospective cohort study of 114 patients diagnosed with prolactinomas between 2007 and 2017 was conducted. All patients underwent gadolinium enhanced pituitary MRI and receiver operating characteristic (ROC) analyses were performed. 51.8% of patients in this study were men, with a mean age at the time of diagnosis of 42.32 ± 15.04 years. 48.2% of the total cohort were found to have microadenomas. Baseline serum PRL concentrations were strongly correlated to tumour dimension (r = 0.750, p = 0.001). When performing the ROC curve analysis, the area under the curve was 0.976, indicating an excellent accuracy of the diagnostic method. For a value of 204 μg/L (4338 mU/L), sensitivity and specificity were calculated at 0.932 and 0.891, respectively. When a cut off value of 204 μg/L (4338 mU/L) was used, specificity was 93.2%, and sensitivity 89.1%, acceptable to reliably differentiate between micro- and macro- adenomas.

Neurogranin as a Novel Biomarker in Alzheimer’s Disease

2020 ◽  
Author(s):  
Luisa Agnello ◽  
Caterina Maria Gambino ◽  
Bruna Lo Sasso ◽  
Giulia Bivona ◽  
Salvatore Milano ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Neurological Diseases ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Phosphorylated Tau ◽  
Roc Curve Analysis ◽  
Total Tau ◽  
Novel Biomarkers ◽  
Good Diagnostic Accuracy

Abstract Background In this study, we investigated the possible role of 2 novel biomarkers of synaptic damage, namely, neurogranin and α-synuclein, in Alzheimer disease (AD). Methods The study was performed in a cohort consisting of patients with AD and those without AD, including individuals with other neurological diseases. Cerebrospinal fluid (CSF) neurogranin and α-synuclein levels were measured by sensitive enzyme-linked immunosorbent assays (ELISAs). Results We found significantly increased levels of CSF neurogranin and α-synuclein in patients with AD than those without AD. Neurogranin was correlated with total tau (tTau) and phosphorylated tau (pTau), as well as with cognitive decline, in patients with AD. Receiver operating characteristic (ROC) curve analysis showed good diagnostic accuracy of neurogranin for AD at a cutoff point of 306 pg per mL with an area under the curve (AUC) of 0.872 and sensitivity and specificity of 84.2% and 78%, respectively. Conclusions Our findings support the use of CSF neurogranin as a biomarker of synapsis damage in patients with AD.

scholarly journals Doppler ultrasound for diagnosis of soft tissue sarcoma: efficacy of ultrasound-based screening score

2015 ◽  
Vol 49 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Satoshi Nagano ◽  
Yuhei Yahiro ◽  
Masahiro Yokouchi ◽  
Takao Setoguchi ◽  
Yasuhiro Ishidou ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Ultrasound Imaging ◽  
Operating Characteristic ◽  
Soft Part ◽  
Imaging Modality ◽  
Screening Method ◽  
Area Under The Curve ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
The Mean

Abstract Background. The utility of ultrasound imaging in the screening of soft-part tumours (SPTs) has been reported. We classified SPTs according to their blood flow pattern on Doppler ultrasound and re-evaluated the efficacy of this imaging modality as a screening method. Additionally, we combined Doppler ultrasound with several values to improve the diagnostic efficacy and to establish a new diagnostic tool. Patients and methods. This study included 189 cases of pathologically confirmed SPTs (122 cases of benign disease including SPTs and tumour-like lesions and 67 cases of malignant SPTs). Ultrasound imaging included evaluation of vascularity by colour Doppler. We established a scoring system to more effectively differentiate malignant from benign SPTs (ultrasound-based sarcoma screening [USS] score). Results. The mean scores in the benign and malignant groups were 1.47 ± 0.93 and 3.42 ± 1.30, respectively. Patients with malignant masses showed significantly higher USS scores than did those with benign masses (p < 1 × 10-10). The area under the curve was 0.88 by receiver operating characteristic (ROC) analysis. Based on the cut-off value (3 points) calculated by ROC curve analysis, the sensitivity and specificity for a diagnosis of malignant SPT was 85.1% and 86.9%, respectively. Conclusions. Assessment of vascularity by Doppler ultrasound alone is insufficient for differentiation between benign and malignant SPTs. Preoperative diagnosis of most SPTs is possible by combining our USS score with characteristic clinical and magnetic resonance imaging findings.

scholarly journals Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986401 ◽  
Author(s):  
Stéphanie Lamer ◽  
Jonah Hébert-Davies ◽  
Vincent Dubé ◽  
Stéphane Leduc ◽  
Émilie Sandman ◽  
...  
Keyword(s):  
External Rotation ◽  
Axial Loading ◽  
Interosseous Ligament ◽  
Ankle Motion ◽  
Paired Samples ◽  
Tibiofibular Ligament ◽  
Custom Made ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Careful Management

Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. Study Design: Controlled laboratory study. Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. Clinical Relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

scholarly journals Posaconazole Plasma Concentrations on Days Three to Five Predict Steady-State Levels

2016 ◽  
Vol 60 (9) ◽  
pp. 5595-5599 ◽  
Author(s):  
Jürgen Prattes ◽  
Wiebke Duettmann ◽  
Martin Hoenigl
Keyword(s):  
Steady State ◽  
Operating Characteristic ◽  
Hematological Malignancies ◽  
Fungal Infections ◽  
Plasma Concentrations ◽  
Area Under The Curve ◽  
Oral Solution ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Steady State Levels

ABSTRACTLow posaconazole plasma concentrations (PPCs) have been associated with breakthrough invasive fungal infections. We assessed the correlation between pre-steady-state PPCs (obtained between days 3 and 5) and PPCs obtained during steady state in 48 patients with underlying hematological malignancies receiving posaconazole oral-solution prophylaxis. Pre-steady-state PPCs correlated significantly with PPCs obtained at steady state (Spearmanr= 0.754;P< 0.001). Receiver operating characteristic (ROC) curve analysis of pre-steady-state PPCs revealed an area under the curve (AUC) of 0.884 (95% confidence interval [CI], 0.790 to 0.977) for predicting satisfactory PPCs at steady state.

scholarly journals Diagnosing Syndesmosis Instability: Dynamic Ultrasound versus Arthroscopy: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Noortje Hagemeijer ◽  
Go Sato ◽  
Rohan Bhimani ◽  
Bart Lubberts ◽  
Mohamed Abdelaziz Elghazy ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Sagittal Plane ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Rank Test ◽  
Proximal Tibiofibular Joint ◽  
Interosseous Ligament ◽  
P Values ◽  
Cadaveric Specimen ◽  
Tibiofibular Ligament

Category: Ankle Introduction/Purpose: To evaluate whether sagittal translation could be detected with ultrasound and arthroscopy and to compare the increasing tibiofibular sagittal translation seen with ultrasound (US) and Arthroscopy. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. The ankle syndesmosis was evaluated using a handheld US device (Butterfly iQ, Butterfly Network Inc, Guilford) and arthroscopy with intact-, and after sequent sectioning of anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior- inferior tibiofibular ligament (PITFL). Sagittal plane translation was simulated with 100N of anterior to posterior (A-to-P) and posterior to anterior (P-to-A) hook force which was applied 5cm above of the ankle joint (Figure 1). Pearson’s correlation, one- way repeated measures ANOVA, and Wilcoxon signed-rank test were used for comparison. Three cadavers were measured by two independent observers to assess reliability and analyzed using intraclass correlation coefficients (ICC). Results: A-to-P translation values obtained with US and Arthroscopy had a correlation of -0.14, and P-to-A translation correlation of 0.44. Using US, intact translation was 0.94+-0.62 with A-to-P hook and 0.87+-0.5 with P-to-A hook. Subsequent A- to-P and P-to-A translation increased with 0.07+-0.96mm and 0.04+-0.76 after AITFL cut, with 0.53+-0.9 and 0.15+-0.5 after IOL cut, and with 0.81+-1.3mm and 0.45+-0.8 after PITFL cut (p-values between 0.122 and 0.270) . Using arthroscopy, intact translation was 0.40 +-0.3 with A-to-P hook and 0.99+-0.5 with P-to-A hook. Subsequent A-to-P and P-to-A translation increased from intact with; 0.001+-0.3 and 0.30+-0.4 after AITFL cut, 0.19+-0.4 and 0.74+-0.7 after IOL cut, and 0.40+-0.5 and 1.1+-0.9 after PITFL cut (p-values between 0.005 and 0.037). No statistical differences between US and Arthroscopy were found. Conclusion: US was unable to differentiate between the different stages of injury, even though a similar increase in translation was seen as compared to arthroscopy. Probably this is due to the high variability seen in the US translation values. As US does have several advantages over arthroscopy; availability, non-invasiveness, low costs, and allowance of using the contralateral side as a direct comparison, this technique should be further explored as a potential diagnostic assessment technique of diagnosing occult syndesmotic instability in the sagittal plane.

scholarly journals Evaluation of serum AFP and DCP levels in the diagnosis of early-stage HBV-related HCC under different backgrounds

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096908
Author(s):  
Ting Song ◽  
Lili Wang ◽  
Ruopei Xin ◽  
Liping Zhang ◽  
Yun Tian
Keyword(s):  
Roc Curve ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Early Stage ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Chronic Hbv Infection ◽  
B Virus ◽  
Chronic Hbv

Objective This study compared the diagnostic performance of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) in early-stage hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) under different backgrounds. Methods Patients were enrolled and divided in four groups: chronic HBV infection (CHB), liver cirrhosis (LC), early-stage CHB-HCC, and early-stage LC-HCC. Serum AFP and DCP levels were measured. Receiver-operating characteristic (ROC) curve and area under the curve (AUC) analyses were applied to compare the diagnostic performance of DCP and AFP for HCC. Results In total, 200 patients were enrolled, including 48, 64, 33, and 55 patients with CHB, LC, CHB-HCC, and LC-HCC, respectively. ROC curve analysis revealed that the AUCs of AFP, DCP, and their combination in differentiating early-stage LC-HCC from LC were 0.776, 0.758, and 0.786, respectively. The values of these markers in discriminating early-stage CHB-HCC from CHB were 0.828, 0.731, and 0.862, respectively. Conclusions DCP was inferior to AFP in differentiating early-stage CHB-HCC from CHB. However, AFP and DCP displayed similar performance in distinguishing early-stage LC-HCC and LC.

scholarly journals Arthroscopic Characterization of Syndesmotic Instability

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Mohamed Abdelaziz ◽  
Jafet Massri-Pugin ◽  
Bart Lubberts ◽  
Bryan Vopat ◽  
Daniel Guss ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Stress Test ◽  
Ankle Arthroscopy ◽  
Coronal Plane ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Interosseous Ligament ◽  
P Values ◽  
Intact State ◽  
Lateral Incision

Category: Arthroscopy, Sports, Trauma, Other, Syndesmosis Introduction/Purpose: Ankle arthroscopy is increasingly used to diagnose syndesmostic instability by visualizing the distal tibiofibular articulation and applying a lateral fibular stress. Precisely where in the incisura one should measure potential diastasis, however, remains unclear. The purpose of this study was to determine where within the incisura one should assess coronal plane instability in purely ligamentous syndesmotic injuries when performing a lateral hook stress test (LHT). Methods: Twenty-two above-knee cadaveric specimens underwent ankle arthroscopy, first with intact ligaments and thereafter after each sequential step of syndesmotic and deltoid ligament transection. At each step, a standard 100 N hook test was applied through a lateral incision 5 cm proximal to the ankle joint and the coronal plane diastasis in the stressed and unstressed states were measured at both anterior and posterior third of the distal tibiofibular joint using calibrated probes ranged from 0.1 to 6.0 mm, with 0.1 mm of increments. Results: Anterior third diastasis did not change significantly when applying a LHT, neither in the intact state nor after any stage of ligament transection (P values ranging from p=0.61 to p=0.94). In contrast, posterior third diastasis increased significantly by applying stress at the intact state at the following stages of transection: posterior-inferior tibiofibular ligament (PITFL), PITFL plus interosseous ligament, all syndesmosis ligaments, and all syndesmosis ligaments plus superficial and deep deltoid ligament (P values ranging p=0.001 to p=0.031). Interobserver agreement was substantial (ICC = 0.81; 95% confidence interval, 0.44-0.92), and moderate (ICC = 0.73; 95% confidence interval, 0.36-0.87) for anterior and posterior third diastasis measurements, respectively. Conclusion: Syndesmotic ligament injury results in coronal plane instability of the distal tibiofibular articulation that is readily identified arthroscopically with a LHT and when measured in the posterior third of the incisura. Measurement at the anterior third of the incisura may miss such injuries.

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