A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes: a preliminary study

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Mei-Dan, Omer¹; Kots, Eugene²; Barchilon, Vidal¹; Massarwe, Sabri¹; Nyska, Meir¹; Mann, Gideon^1,3

A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes: a preliminary study

Am J Sports Med. May 2009;37(5):1009-1016

©2009 American Orthopaedic Society for Sports Medicine

Affiliations

¹Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel

²Department of Radiology, Meir University Hospital, Kfar-Saba, Israel

³Ribstein Center for Sport Medicine, Sciences and Research, Wingate Institute, Netanya, Israel
Abstract and keywords

Background: Syndesmotic ankle injuries are not easy to recognize when an associated fracture or frank diastasis is not present. There is a need for a simple, fast, inexpensive, and easily reproducible diagnostic tool to assess the integrity of the distal tibiofibular synedesmosis.

Hypothesis: Dynamic ultrasound (US) examination can accurately diagnose anteroinferior tibiofibular ligament (AITFL) rupture.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: We evaluated 3 groups: 9 consecutive professional athletes with recent AITFL rupture, a control group of 18 subjects without a history of ankle injury, and 20 patients with lateral ankle sprain. The dynamic US examination was performed in neutral (N), forced internal rotation (IR), and external rotation (ER) of the foot for measuring the tibiofibular clear space on the anterior aspect of the ankle, at the level of the AITFL, 1 cm proximal to the joint line.

Results: The mean age of the study group was 27 years (range, 16–32). Magnetic resonance imaging (MRI) confirmed the diagnosis of AITFL rupture in all cases. Differences between the injured and control group were statistically significant for the N, IR, and ER positions (P < .001) and for the measured Δ between the AITFL in the ER and N positions (P < .01). The difference in the tibiofibular clear space between the 2 ankles of the injured athletes was significantly different compared with the control athletes for all 3 positions (P < .001). The measured difference between the ER and N positions for both sides of the study group showed a specificity and sensitivity of 100% (P < .001; cutoff point of 0.9 mm and 0.7 mm, respectively). The Δ (Δ = ER – N) of the injured side showed a specificity and sensitivity of only 89% (P < .001; cutoff point of 0.4 mm). Additionally, the third group with the history of lateral ankle sprain showed, as expected, that this type of injury does not correlate with AITFL injury on dynamic US examination.

Conclusion: We conclude that dynamic US examination can be used to accurately diagnose an AITFL rupture. This preliminary study has found the described method to be a simple, inexpensive, and easily reproducible examination.

Keywords: syndesmosis; ultrasound; dynamic examination; external rotation
Links

DOI: 10.1177/0363546508331202

PubMed: 19336613

WoS: 000265689600022

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Year	Entry
2011	Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. J Chiropr Med. September 2011;10(3):204-219.
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2014	Randelli P, Menon A, Ragone V, Baron D, Bonasia DE, Carmont MR, Compagnoni R, Hantes M, Hulet C, Järvelä T, Karahan M, Kerkhoffs G, Pineau V, Reurink G, Rochcongar G, Rossi R, Siebold R, Spennacchio P, Suomalainen P, Cabitza P, Banfi G. Lower limb. In: Zaffagnini S, Becker R, Kerkhoffs GMMJ, Mendes JE, van Dijk CN, eds. ESSKA Instructional Course Lecture Book. Heidelber, Germany: Springer; 2014:233-272.
2022	Esfahani SA, Bhimani R, Lubberts B, Kerkhoffs GM, Waryasz G, DiGiovanni CW, Guss D. Volume measurements on weightbearing computed tomography can detect subtle syndesmotic instability. J Orthop Res. February 2022;40(2):460-467.
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