Defining the three most responsive and specific CT measurements of ankle syndesmotic malreduction.

Autor: Schon JM; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Brady AW; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Krob JJ; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Lockard CA; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Marchetti DC; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Dornan GJ; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA., Clanton TO; Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA. tclanton@thesteadmanclinic.org.; The Steadman Clinic, Vail, CO, USA. tclanton@thesteadmanclinic.org.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2019 Sep; Vol. 27 (9), pp. 2863-2876. Date of Electronic Publication: 2019 Apr 24.
DOI: 10.1007/s00167-019-05457-8
Abstrakt: Purpose: The purpose of this study was to compare the reliability and accuracy of existing computed tomography (CT) methods for measuring the distal tibiofibular syndesmosis in uninjured, paired cadaveric specimens and in simulated malreduction models. It was hypothesized that a repeatable set of measurements exists to accurately and quantitatively describe the typical forms of syndesmotic malreduction using contralateral ankle comparison.
Methods: Twelve cadaveric lower-leg specimen pairs were imaged with CT to generate models for this study. Thirty-five measurements were performed on each native model. Next, four distinct fibular malreductions were produced via digital simulation and all measurements were repeated for each state: (1) 2-mm lateral translation; (2) 2-mm posterior translation; (3) 7-degree external rotation; (4) the previous three states combined. The modified standardized response mean (mSRM) was calculated for each measurement. To assess rater reliability and side-to-side agreements of the native state measurements, intraclass correlation coefficients (ICC) and Pearson correlation coefficients (PCC) were calculated, respectively.
Results: The most responsive measurements for detecting isolated malreduction were the Leporjärvi clear space for lateral translation, the Nault anterior tibiofibular distance for posterior translation, and the Nault talar dome angle for external rotation of the fibula. These measurements demonstrated fair to excellent inter-rater ICCs (0.64-0.76) and variable side-to-side PCCs (0.14-0.47).
Conclusions: The most reliable method to assess the syndesmosis on CT was to compare side-to-side differences using three distinct measurements, one for each type of fibular malreduction, allowing assessment of the magnitude and directionality of syndesmosis malreduction. Reliable evaluation is essential for assessing subtle syndesmosis injuries, malreduction and surgical planning.
Databáze: MEDLINE
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