Ankle syndesmosis injuries

NewsBot · Sep 6, 2019

Clinical Evidence for Treatment of Distal Tibiofibular Syndesmosis Injury: A Systematic Review of Clinical Studies
Guoming Liu, MD et al
JFAS Article in Press

No consensus had been reached about the optimal treatment for syndesmotic fixation. We performed a review of randomized controlled trials (RCTs) to assist in clarifying many of the controversies that were debated for years despite new technology and options. PubMed, Embase, and the Cochrane Library were searched through specific terms and limits. Only RCTs were selected for final inclusion. Study screening and data extraction were performed independently by 2 reviewers. Thirteen RCTs, including 828 cases, met the inclusion criteria and are summarized in this review. Pooled results demonstrated that dynamic fixation had better functional outcomes as well as lower rates of malreduction and complications compared with syndesmotic screw fixation. Both absorbable screw and tricortical screw fixation showed similar results to quadricortical metallic screws. Therefore, dynamic fixation is recommended for the treatment of syndesmosis injuries.
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NewsBot · Sep 7, 2019

Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study
Pieter D'Hooghe et al
BJSM

Objectives To evaluate time to return to play following surgical stabilisation of isolated unstable syndesmosis injuries in a cohort of professional male football players.

Methods All professional football players undergoing surgery for isolated unstable syndesmosis injury (West Point grade ≥IIB) at a specialised Orthopaedic and Sports Medicine Hospital were followed up until return to play (minimum ≥6 months). Players with a stable syndesmosis, injuries older than 6 weeks, concomitant medial or lateral malleolar fracture or previous ankle surgery were excluded. During rehabilitation, time required to return to sports-specific rehabilitation, team training and first match play, were recorded.

Results Between January 2012 and December 2017, a total of 110 male professional football players were included. The mean time required to begin on field rehabilitation was 37±12 days, while the mean time to return to team training was 72±28 days. The first official match was played on average 103±28 days postoperatively. Multivariable analysis revealed that the severity of injury, the concomitant presence of talar cartilage injury and the age of the player were significantly associated (p<0.00001) with time to return to on field rehabilitation, team training and match play.

Conclusion In this cohort of professional football players, surgical stabilisation of isolated unstable syndesmosis injuries (West Point grade ≥IIB) allowed for relatively quick return to play. High grade injury (West Point grade III), concomitant cartilage injury and greater age were associated with longer return to play times.
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NewsBot · Sep 30, 2019

High Ankle Sprains in Professional Ice Hockey Players: Prognosis and Correlation Between Magnetic Resonance Imaging Patterns of Injury and Return to Play
Brent Mollon, MD, MSc, FRCSC, David Wasserstein, MD, MSc, FRCSC, Gráinne M. Murphy, MB, BCh, BAO, MMedSci, FFR, RCSI, ...
Orthopaedic Journal of Sports Medicine September 27, 2019

Background:
Hockey players sustain a greater incidence of ankle syndesmosis injuries than other athletes. These injuries have a higher morbidity and more unpredictable recovery than lateral ankle sprains. Magnetic resonance imaging (MRI) has been used to establish the diagnosis but has not been evaluated for its ability to predict return to play.

Hypothesis:
We hypothesized that patterns of injury defined on MRI could be used to predict return to play in a cohort of professional hockey players with syndesmosis sprains.

Study Design:
Cohort study; Level of evidence, 3.

Methods:
A prospectively collected National Hockey League (NHL) database was analyzed from the 2006-2007 to 2011-2012 seasons to assess return to play after an injury. A separate retrospective review of ankle MRI scans from professional hockey players with a documented high ankle sprain sustained between 2007 and 2012 was performed. Injuries were classified on MRI as complete or partial tears of the anterior-inferior tibiofibular ligament (AITFL), posterior-inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), and deltoid ligament. Fractures, bone contusions, and osteochondral lesions were also recorded.

Results:
A total of 105 NHL athletes sustained high ankle sprains over the 5 seasons studied. Of these athletes, 85 were unable to play and missed a median of 8 games (range, 0-65 games). A retrospective MRI evaluation of 21 scans identified complete AITFL tears in 13 (62%) and high-grade partial tears in 5 (24%) cases. In contrast, the PITFL was partially torn in 9 (43%) and normal in 12 (57%) cases. Bone contusions were seen in 71% of cases and lacked a consistent pattern. The most commonly associated ligamentous injury was of the ATFL, which was injured in 52% of cases (11/21; 3 complete and 8 partial). There was no difference in the mean number of days lost when players were stratified by patterns of injury (incomplete/complete AITFL tear ± additional ligamentous injury, bone contusion, syndesmosis width).

Conclusion:
A high ankle sprain resulted in significant variations in time of recovery among professional hockey players. A torn AITFL and bone bruising were the most common patterns of injury. Although MRI can be used to confirm the diagnosis of a syndesmosis injury, it did not predict return to play in this population.
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NewsBot · Jan 20, 2020

Internal tibial torsion is related to syndesmosis injury in a large osteological collection.
McCarthy CF et al
Foot Ankle Surg. 2020 Jan 9

BACKGROUND:
The long-term consequences of tibial torsion remain unclear. This study evaluated whether syndesmotic injuries are associated with tibial torsion.

METHODS:
A collection of over 3000 cadaveric skeletons was screened for irregular bony prominence along the lateral distal tibia, consistent with previous syndesmosis injury. Tibial torsion was measured and compared to 1034 control cadaveric tibiae.

RESULTS:
Mean torsion of 236 specimens with syndesmotic injury was 6.2±8.9 degrees, while that of control specimens was 7.9±8.8 degrees (P = 0.008). Multiple regression analysis showed a non-statistically significant trend toward internal torsion and syndesmotic injury (standardized beta=-0.051, P=0.059). Syndesmosis injury was present in 48/200 specimens (24.0%) with internal torsion and 31/199 specimens (15.6%) with external torsion (P=0.035).

CONCLUSION:
This association between internal tibial torsion and syndesmotic injury suggests that internal tibial torsion might not be an entirely benign condition and merits further study.
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NewsBot · Oct 23, 2020

Mechanisms of acute ankle syndesmosis ligament injuries in professional male rugby union players: a systematic visual video analysis
Eamonn Delahunt et al
British Journal of Sports Medicine Published Online First: 13 October 2020

Background The mechanisms of acute ankle syndesmosis ligament injuries in professional rugby union are not well understood.

Aim To describe the mechanisms of acute ankle syndesmosis ligament injuries in male professional rugby union players using systematic visual video analysis.

Methods All time-loss acute ankle syndesmosis ligament injuries identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2013/2014 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three Chartered Physiotherapists (analysts) independently assessed all videos with a final consensus meeting convened to describe the injury mechanisms. One of the analysts developed a qualitative description of each injury mechanism.

Results Thirteen acute ankle syndesmosis injuries were included in this study. The most common biomechanical presentation of the injured limb was characterised by hip flexion, knee flexion, knee valgus, ankle dorsiflexion, pronation and external rotation of the foot. Six of the included injuries (46%) were the result of an external load application to the injured limb (ie, direct contact injuries). In the other seven instances (54%), the injury was the result of a collapse of the injured player’s body mass over the injured ankle joint, while tackling or being tackled, without direct contact to the injured limb (ie, indirect contact injuries).

Conclusion Injuries incurred while tackling were exclusively the result of suboptimal tackle mechanics. A majority of injuries incurred while being tackled involved a posterior tackle, which often resulted in a posterior collapse of the injured player’s centre of mass over a fixed externally rotated foot.
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NewsBot · Mar 22, 2021

Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: a systematic review with meta-analysis
Netterström-WedinF BleakleyC
Physical Therapy in Sport; 20 March 2021

Highlights
•This is the first meta-analysis of clinical tests for the ankle syndesmosis
•Sensitive (palpation;dorsiflexion lunge) and specific (squeeze) tests are recommended
•None of the 13 clinical tests exhibits both high sensitivity and high specificity
•No current evidence suggests that clinical tests, in isolation, can dictate surgery
•No evidence suggests that clinical tests (in isolation) can grade the level of injury
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Objective
To summarise and evaluate research on the diagnostic accuracy of clinical tests for ligamentous injury of the ankle syndesmosis.

Methods
CINAHL, Embase, and MEDLINE were searched from inception to 12 February 2021. Studies comparing clinical examination to arthroscopy, magnetic resonance imaging, or ultrasound were considered eligible. Meta-analysis was based on random effect modelling and limited to studies fulfilling all QUADAS-2 criteria. Sensitivity (SN), specificity (SP) and likelihood ratios determined diagnostic accuracy, all with 95% confidence intervals (CI).

Results
Six studies were included (512 participants; 13 clinical tests; 29% median prevalence). No individual test was associated with both high sensitivity and high specificity.Tests with the highest sensitivity were: palpation [SN 92% (95%CI 79–98)] and dorsiflexion lunge [SN 75% (95% CI 64–84%); n=2 studies]. Tests with the highest specificity were: squeeze test [SP 85% (95% CI 81–89%); n=4 studies] and external rotation [SP 78% (95% CI 73–82%); n=4 studies].

Conclusions
Clinical examination should involve initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge), followed by a test with high specificity (squeeze). However, as these tests cannot definitively stratify syndesmotic injuries into stable vs unstable, decisions on optimal management (conservative vs surgery) require additional imaging or arthroscopy.
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NewsBot · Oct 19, 2021

Determination of the Optimal Syndesmosis Fixation Angle Using Mortise View of The Ankle Joint
Oğuzhan Tanoğlu; İzzet Özay Subaşı; Mehmet Burak Gökgöz
J Am Podiatr Med Assoc 21-034.

Background: Syndesmosis is an important soft tissue component supporting the ankle stability and commonly injured accompanying with ankle fractures. The accurate reduction and fixation of syndesmosis is essential to obtain better functional results. Therefore, we aimed to find a practical method using the mortise view of ankle to determine the optimal syndesmosis fixation angle intraoperatively. Methods: We randomly selected 200 adults (100 women and 100 men) between 18 - 60 years of age. Three-dimensional anatomical models of tibia and fibula were created using Materialise MIMICS 21. We created a best fit plane on articular surface of medial malleolus and a ninety degrees vertical plane to medial malleolus plane. We determined two splines on cortical borders of tibia and fibula distant from the most superior point of ankle joint in horizontal view. We created two spheres that fit to the predefined splines. The optimal syndesmosis fixation angle was determined measuring the angle between the line connecting the center points of spheres, and the ninety degrees vertical plane to medial malleolus plane. Results: We observed no statistically significant difference between gender groups in terms of optimal syndesmosis fixation angles. The mean age of our study population was 47.1 {plus minus} 10.5. The optimal syndesmosis fixation angle according to mortise view was found as 21 {plus minus} 4.3 degrees. Conclusions: We determined the optimal syndesmosis fixation angle as 21 {plus minus} 4.3 degrees in accordance with the mortise view of ankle. The surgeon could evaluate the whole articular surface of ankle joint with the medial and lateral syndesmotic space in mortise view accurately and at the same position syndesmosis fixation could be performed at 21 {plus minus} 4.3 degrees.
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NewsBot · Feb 3, 2022

Syndesmosis Injury Contributes a Large Negative Effect on Clinical Outcomes: A Systematic Review
John J. Heifner, MD, MS, Jack E. Kilgore, III, BS, Jennifer A. Nichols, PhD, ...
Foot & Ankle Specialist January 20, 2022

Introduction:
The literature largely addresses questions of diagnostic accuracy and therapeutic accuracy. However, the magnitude of the clinical impact of syndesmosis injury is commonly described in intuitive yet qualitative terms. This systematic review aimed to quantify the impact of syndesmosis injury.

Methods:
Published clinical outcomes data were used to compute an effect size reflecting the impact of syndesmosis injury. This was done within the clinical contexts of isolated syndesmosis injury and syndesmosis injury with concomitant ankle fracture. Clinical outcomes data included Olerud-Molander (OM) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale for pain, and days missed from sport competition. Parametric data were compared with Student t tests. Effect size was computed using Cohen’s d.

Results:
In ankle fracture patients, syndesmosis injury demonstrated a large effect size for OM (d = 0.96) and AOFAS (d = 0.83) scores. In athletic populations without concomitant ankle fracture, syndesmosis injury demonstrated a large effect size on days missed from competition (d = 2.32).

Discussion:
These findings confirm the magnitude of the negative impact of syndesmosis injury in athletic populations with isolated injury and in ankle fracture patients. In ankle fracture patients, this large negative effect remains despite surgery. Thus, syndesmosis repair may not fully mitigate the impact of the injury.
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NewsBot · Mar 3, 2022

Elite Athletes Successfully Return to the Preinjury Level of Sport Following Ankle Syndesmosis Injuries
A Systematic Review and Meta-Analysis
Bolia, Ioanna K. MD, MS, PhD; Bogdanov, Jacob BS; Schoell, Kyle MD; Ouyang, Yuxin BS; Petrigliano, Frank A. MD; Weber, Alexander E. MD; Tan, Eric W. MD
Clinical Journal of Sport Medicine: March 1, 2022 - Volume - Issue -

Objective:
To comprehensively review and report the outcomes of ankle syndesmotic injury management in elite athletes.

Data sources:
Three databases were searched for articles reporting the rate of return to sport following treatment of ankle syndesmotic injuries in elite athletes (collegiate or professional level). Ten articles and 440 athletes were included. Articles reporting the rate of return to sport following high ankle sprain injury in elite athletes. Data collected included demographics, type of treatment received, and return to sport (RTS) information. A random effects model was used.

Main results:
The estimated overall rate of RTS was 99% (95% CI, 95.5-99.9). The mean time to RTS was 38 ± 18 (range, 14-137) days. Of the 440 athletes, 269 (269/440%, 61%) were treated nonoperatively (nonoperative group); the rate of RTS was 99.6%, and the athletes returned at a mean time of 29 ± 14 (range, 13-45) days. A total of 171 athletes (171 of 440%, 39%) underwent surgical treatment (operative group). All (171 of 171%, 100%) athletes returned at a mean time of 50.3 ± 13 (range, 41-137) days. Almost all athletes who underwent surgery had suture button fixation (164 of 171 athletes, 96%), and the mean time to RTS was 7 weeks with 9.1% complication rate.

Conclusions:
Elite athletes with ankle syndesmosis injury return to sport at an extremely high rates, following operative or nonoperative treatment. Return to the preinjury level of competition should be expected at 4 weeks and 7 weeks in high-level athletes who undergo nonoperative and operative management, respectively. Suture button fixation was used by the majority of studies reporting surgical management of ankle syndesmosis injuries in athletes.
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NewsBot · Apr 11, 2022

Current status of the management of isolated syndesmotic injuries in Germany
Manuel Mutschler et al
Arch Orthop Trauma Surg. 2022 Apr 11

Introduction: Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany.

Materials and methods: An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS.

Results: Each question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior-posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices.

Conclusions: While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.
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NewsBot · Jun 5, 2022

Incidence of OsteoChondral Lesions of the Ankle in Isolated Syndesmotic Injuries -A Systematic Review and Meta-Analysis
Jari Dahmen et al
Cartilage. Apr-Jun 2022

NewsBot · Jan 24, 2023

Diagnosis of subtle syndesmotic instability using conventional CT-imaging and axial force in different foot positions
JuanChans-Veresa et al
Foot and Ankle Surgery; 11 January 2023

Background
Currently, there is no available method that can objectively and reliably detect subtle instability of the distal tibiofibular joint. The purpose of this study is to diagnose, using computerized axial tomography and an adjustable simulated loading device, subtle instability of the tibiofibular syndesmosis.

Methods
Fifteen healthy individuals and 15 patients with clinical suspicion of subtle instability of the tibiofibular syndesmosis (total 60 ankles) were studied using an adjustable simulated loading device (ASLD). This device allows to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID), anterior direct difference (ADD), middle direct difference (MDD) and posterior direct difference (PDD).

Results
Statistically significant differences were observed in the variable syndesmotic area between healthy (mean=−0.14, SD=4.33) and diseased (mean=16.82, SD=12.3)(p < 0.001). No statistically significant differences were found in the variables ADD, MDD, PDD, ID, FPS and FR.

Conclusions
Measurement of syndesmotic area employing axial force and forced foot positions using the ASLD may be useful for the diagnosis of subtle tibiofibular syndesmosis instability.
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NewsBot · Jun 29, 2023

Early versus late weight-bearing in operatively treated ankle fractures with syndesmotic injury: A systematic review
Julia Lazarow et al
Foot (Edinb). 2023 Feb 2

Background: Over the past 30 years, several studies have compared early weight-bearing versus late weight-bearing following open reduction and internal fixation of ankle fractures; however, no review strictly including patients with ankle fractures and complete syndesmotic disruption has been performed.

Objective: The objective of this systematic review was to compare early versus late weight-bearing following surgery for ankle fracture with syndesmotic injury regarding clinical and patient-reported outcomes.

Methods: A comprehensive search strategy was applied to the Cochrane Library, MEDLINE, Embase, CINAHL and PubMed databases from their inception to the 17th of January 2022. The articles were screened independently by two blinded reviewers. Data were extracted by one author, then cross-checked and approved by the other.

Results: No comparative studies were found; therefore, studies describing either early or late weight-bearing were included. It was thus not possible to perform a meta-analysis. 11 studies and 751 patients were included. An early partial weight-bearing protocol was used in three studies (253 patients) and late in eight studies (498 patients). Functional outcomes suggested that there were no clear differences between early partial weight-bearing and late weight-bearing. The reoperation rate was 9-31% in the early group and 0-11% in the late. Similar results were seen for loss of syndesmotic reduction, malreduction, infection, and fixation failure.

Conclusion: Pros and cons were reported for early partial weight-bearing and late weight-bearing, but the evidence was very limited as our results were based on noncomparative studies. In the future, high-quality comparative studies focusing on functional outcomes within 6 months postoperatively are needed
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NewsBot · Sep 10, 2023

The Clinical Outcomes of Syndesmotic Flexible Fixation for Syndesmotic Injury With Ankle Fracture
Sung Hwan Kim, MD, Sang Heon Lee, MD, and Young Koo Lee, MD, PhD
Source

Background:
We evaluated whether the quality of syndesmotic reduction affects the short-term clinical outcomes of flexible fixation in patients with a rotational ankle fracture.
Methods:
This study included 59 patients (32 men and 27 women) who underwent syndesmotic flexible fixation. The degree of syndesmotic reduction was evaluated on computed tomography (CT) images acquired within 3 days after surgery. We measured the divergence between anterior and posterior incisura at 1 cm above the distal tibial articular joint, then evaluated the degree of fibular rotation relative to the tibia. At 1 year after surgery, an objective clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, the visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Additionally, repeat arthroscopy was performed during routine implant removal at nearly 1 year postoperatively.
Results:
Among 59 patients who underwent syndesmotic flexible fixation, 56 patients had syndesmotic stability on repeat arthroscopy. At 1 year postoperation, AOFAS, VAS, and FAOS scores were, respectively, 90, 2.0, and 94 in the accurate reduction group (n = 24) and 90, 1.0, and 94.5 in the malreduction group (n = 35).
Conclusion:
Reduction quality after syndesmotic injury with flexible fixation, as determined by early postoperative CT imaging, did not affect patient prognosis. In this cohort, syndesmotic reduction and flexible fixation may produce good clinical outcomes in patients with syndesmotic injury and ankle fracture.
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NewsBot · Jan 8, 2024

Is Tenderness of Medial Malleolus Circumference a Sign of Syndesmosis Injuries?
Ugur Onur Kasman, Serkan Surucu, Ozgur Korkmaz
J Am Podiatr Med Assoc. 2023 Nov-Dec;113(6):22-128.

Background: Syndesmosis injuries occur in approximately 10% of all ankle fractures. The integrity of the deltoid ligament is important in the decision of surgical treatment of lateral malleolus fractures.

Methods: Patients who were operated on for Weber B ankle fracture were evaluated retrospectively, and the relationship between tenderness around the medial malleolus and syndesmosis injury was investigated. Patients with visual analog scale, Foot and Ankle Ability Measure daily living, and sports activity scores in their files were included. This study enrolled 38 patients. The patients were divided into two groups. Group 1 consisted of patients with a medial space greater than 4 mm on preoperative radiographs and a positive intraoperative Cotton test, in which a syndesmosis screw was used. Group 2 consisted of patients with a medial space less than 4 mm on preoperative radiographs and negative intraoperative Cotton test, for whom no syndesmosis screw was used.

Results: In 17 of 38 patients, syndesmosis screws were used because of intraopeative positive Cotton test. In 21 patients, the Cotton test was negative and the syndesmosis screw was not used. Comparing the groups statistically revealed no statistically significant difference in all scores. Tenderness around the medial malleolus was detected in two patients in group 2 and nine patients in group 1. A statistically significant difference was detected in terms of medial clear space values and tenderness around the medial malleolus between both groups.

Conclusions: The absence of tenderness around the medial malleolus in Weber B ankle fractures indicates no syndesmosis injury, whereas the presence of tenderness around the medial malleolus does not mean that there is a syndesmosis injury.
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NewsBot · Jan 15, 2024

Standing on single foot-binding test yields satisfactory results as a novel method for the diagnosis of distal tibiofibular syndesmosis instability: a prospective, cross-sectional diagnostic-accuracy study
Shouqi Sun et al
BMC Musculoskelet Disord. 2024 Jan 12;25(1):53

Background: Non-invasive diagnosis of distal tibiofibular syndesmosis instability (DTSI) was a great challenge to clinicians. We designed a new method, the Standing on single foot-Binding test, and investigated the accuracy of the test in the diagnosis of distal tibiofibular syndesmosis instability in adults with a history of ankle injury.

Methods: 85 participants with ankle injury were subjected to the Standing on single foot-Binding test, MRI and palpation to detect the distal tibiofibular syndesmosis instability (DTSI) and the findings were compared with ankle arthroscopic results. Both participants and arthroscopist were blind to the predicted results of the clinical tests. Sensitivity, specificity, PPV, NPV, LR+, LR - and their 95% CIs were calculated for each of the clinical tests as well as for the positive clinical diagnosis.

Results: The Standing on single foot-Binding test (SOSF-B test) outperformed MRI and palpation, in terms of sensitivity (87.5%/84.38%), specificity (86.79%/86.79%), PPV (80%/79.41%), NPV (92%/91.2%), LR+ (6.625/6.39), LR- (0.14/0.18) and diagnostic accuracy (87.06/85.88), among others, in the diagnosis of distal tibiofibular syndesmosis instability (DTSI). The diagnostic performance of 20° SOSF-B test was virtually identical to that of 0° SOSF-B test. According to the prevalence (28.7%) of DTSI and LR of four tests, the post-test probability could be used in clinical practice for the prediction of DTSI.

Conclusion: This prospective and double-blind diagnostic test showed that the SOSF-B test is clinically feasible for the diagnosis of distal tibiofibular syndesmosis instability (DTSI), and new diagnostic tools for rapid screening of distal tibiofibular syndesmosis instability (DTSI).
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Ankle syndesmosis injuries

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Ankle Surgery - Syndesmosis Repair - What to Expect?

Dysplasia epiphysealis hemimelica (Trevor's disease) in the foot and ankle

Sudden exertions causing acute pain at ankle/top of foot

Workers' Compensation After Foot and Ankle Surgery

Burning pain outer left foot/ankle

Controlled ankle motion (CAM) Walker boots

Mental health and outcomes of foot and ankle surgery

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Ankle syndesmosis injuries

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Ankle Surgery - Syndesmosis Repair - What to Expect?

Dysplasia epiphysealis hemimelica (Trevor's disease) in the foot and ankle

Sudden exertions causing acute pain at ankle/top of foot

Workers' Compensation After Foot and Ankle Surgery

Burning pain outer left foot/ankle

Controlled ankle motion (CAM) Walker boots

Mental health and outcomes of foot and ankle surgery

Share This Page

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