Clinical Significance of Lateral Ankle Radiograph after the Reduction of a Syndesmosis Injury

ObjectivesTo determine the diagnostic reliability of the Schneck grading system for acute ligamentous injuries of (1) the three major ligamentous ankle complexes, (2) the individual ankle ligaments and (3) the Sikka classification for syndesmosis injury.MethodsAll acute ankle injuries in adult athletes (≥18 years), presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital, within 7 days postinjury were screened for inclusion. Ankle injuries were excluded if imaging demonstrated a frank ankle fracture or if the 3 T MRI study could not be acquired within 10 days postinjury. Two radiologists graded the three major ligamentous complexes (lateral ankle complex, deltoid complex and syndesmosis complex) and their comprising individual ligaments according the four-grade Schneck grading system. Syndesmotic injuries were classified according the four-grade Sikka classification for consequent injury of the individual syndesmosis ligaments and the deltoid complex. Agreement and kappa (K) statistics were calculated to determine intrarater and interrater reliability.ResultsBetween September 2016 and September 2018, a total of 92 MR scans were obtained (87 patients). Interrater and intrarater reliability of the Schneck grading system was moderate to substantial for the lateral ankle complex (K=0.47–0.76), fair to almost perfect for the syndesmosis complex (K=0.37–0.89) and fair to moderate for the deltoid complex (K=0.14–0.51). For the individual ligaments, kappa values ranged from moderate to substantial for the anterior talofibular ligament (ATFL) (K=0.55–0.73), fair to substantial for the calcaneofibular ligament (K=0.31–0.62) and fair to almost perfect for the anteroinferior tibiofibular ligament (AITFL) (K=0.36–0.89). Diagnostic reliability of the Sikka classification ranged from moderate to almost perfect (K=0.51–0.95).ConclusionsGrading of the three major ligamentous complexes and of the individual ankle ligaments according the Schneck grading system resulted in limited diagnostic reliability. When dichotomised for the presence of complete discontinuity, the interrater reliability of the Schneck grading system improved to substantial and almost perfect for the ATFL and AITFL, respectively. Classification of syndesmosis injury according the Sikka classification resulted in moderate interrater reliability.

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Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

Korean Journal of Radiology ◽

10.3348/kjr.2015.16.5.1096 ◽

2015 ◽

Vol 16 (5) ◽

pp. 1096 ◽

Cited By ~ 22

Author(s):

Ka-Young Chun ◽

Yun Sun Choi ◽

Seok Hoon Lee ◽

Jin Su Kim ◽

Ki Won Young ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ankle Instability ◽

Deltoid Ligament ◽

Tibiofibular Syndesmosis ◽

Resonance Imaging ◽

Imaging Evaluation ◽

Lateral Ankle ◽

Magnetic Resonance Imaging Evaluation ◽

Syndesmosis Injury ◽

Lateral Ankle Instability

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Clinical significance and morphological analysis of the os subfibulare using radiologic assessment in patients with chronic lateral ankle instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00305 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0030

Author(s):

Doo Jae Lee ◽

Dong Yeon Lee ◽

Jae Hee Lee

Keyword(s):

Clinical Significance ◽

Morphological Analysis ◽

Ankle Instability ◽

Treatment Plan ◽

Anterior Talofibular Ligament ◽

Mr Images ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Radiologic Assessment ◽

Lateral Ankle Instability

Category: Ankle Introduction/Purpose: Although os subfibulare has been associated to various clinical problems in patients with chronic lateral ankle instability (CLAI), there are a few studies on the analysis of morphological characteristics of os subfibulare. The purpose of this study is to analyze morphologic characteristics of the os subfibulare and to evaluate the clinical significance of the os subfibulare in patients with CLAI. Methods: Among 252 patients who visited our training hospital with the symptom of lateral ankle instability for more than 1 year after sustaining ankle injury, 71 patients with os subfibulare who underwent magnetic resonance imaging (MRI) of the ankle were included in this study. For each patient, the simple radiologic assessment was also performed. The shape and size of ossicles were measured on a sagittal MR images. The location of the subfibular ossicle was classified into 3 zones by relation with the attachment site of the anterior talofibular ligament. The talofibular impingement, in which ossicles impinged to the talar articular surface. Results: The most common shape of ossicles was oval, and the most common site of ossicles was ATFL attach site. 61% of patients showed talofibular joint impingement on axial MR images, whereas 28 cases showed normal congruency of the talofibular joint. Forty-eight cases in 71 patients with CLAI had an enlarged fibular shape instead of a contralateral fibula on simple radiographs. The age; sex; the shape, location, and size of the ossicle; talofibular articular impingement; and history of major trauma were associated with surgical treatment in statistical analysis. Conclusion: The morphological analysis of the os subfibulare revealed that the ossicle manifested radiographic differences based on its size, location, and morphology. Based on the findings of our study, we suggest it is crucial to understand the morphologeical characteristics of the os subfibulare in patients with CLAI and to establish the treatment plan accordingly.

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Clinical Significance of Lateral Ankle Radiograph after the Reduction of a Syndesmosis Injury

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00470 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0047

Author(s):

Jae Wan Suh ◽

Sunghyun Kim ◽

Hyun-woo Park

Keyword(s):

Screw Fixation ◽

Lateral View ◽

Lateral Radiograph ◽

Lateral Ankle ◽

Radiographic Parameters ◽

Tibial Plafond ◽

Posterior Malleolus ◽

Radiographic Measurements ◽

Syndesmosis Injury ◽

Mortise View

Category: Trauma Introduction/Purpose: To introduce reliable and newly developed radiographic measures based on a lateral ankle radiograph to assess a syndesmotic reduction after screw fixation and to compare with the radiographic measures based on the anteroposterior (AP) and mortise radiographs. Methods: The postoperative ankle radiographs of 34 ankle fracture cases after screw fixation for concurrent syndesmosis injury were reviewed. Two radiographic parameters were measured on each AP and mortise radiograph; tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). Five radiographic parameters were measured on the true lateral radiographs; the anteroposterior tibiofibular (APTF) ratio, anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR), distances of intersection of the anterior fibular border and the tibial plafond to anterior cortex of the tibia (AA’), and the intersection of posterior fibular border and tibial plafond to the tip of the posterior malleolus (BB’). In addition, the distance (XP) between the fibular posterior margin (X) crossing tibial plafond or the posterior malleolus and posterior articular margin (P) of the tibial plafond was measured on the lateral view. Results: Using TFCS and TFO in the AP and mortise radiographs, malreductions of syndesmosis were estimated in 17 of 34 cases (50.0%). Using the introduced and developed radiographic measures in the lateral radiographs, syndesmotic malreductions were estimated in 16 out of 34 cases (47.1%). Seventeen cases (50.0%) showed no evidence of postoperative diastasis using the radiographic criteria on the AP and mortise view, 10 cases (58.8%) of whom showed evidence of a malreduction on the lateral radiograph. The newly developed measurements, XP, were measured 0 in 11 out of 34 cases (32.4%). Conclusion: The reduction of syndemosis after screw fixation can be accurately assessed intraoperatively with a combination of several reliable radiographic measurements of lateral radiograph and traditional radiographic measurements of AP and mortise radiograph. Using various radiographic parameters selectively, malreduction could be prevented even when some parameters are difficult to measure because of implants or when posterior malleolar fracture is accompanied.

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