Korean J Sports Med.  2021 Mar;39(1):1-9. 10.5763/kjsm.2021.39.1.1.

Radiographic Evaluation of the Normal Distal Tibiofibular Syndesmosis in Neutral to Dorsiflexion on Weight-Bearing

• Shin SK
• Kim KC
• Song SY
• Young KWo
• Lee KT

• KMID: 2513512
• DOI: http://doi.org/10.5763/kjsm.2021.39.1.1

Abstract

Purpose
Reliable landmarks of ankle syndesmosis change in various positions is important for managing ankle injury. The purpose of our study was to investigate and compare radiographic landmarks of normal ankle in various positions.
Methods
The study involved both ankle radiographs of 30 subjects (15 males, 15 females) without clinical or radiographic abnormality. Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO) were measured on anteroposterior (AP) and mortise radiographs in non-standing (NS) and standing (S) neutral and dorsiflexion 10° (DF10) and 20° (DF20). The radiographic measurements were used to calculate means, standard deviations, and intra- and interobserver reliabilities, and compare TFCS and TFO in various positions and genders.
Results
On the AP view, the mean TFCS in NS, S, DF10, and DF20 positions were 4.00±0.97, 4.00±0.83, 4.35±0.95, and 4.45±0.89 mm and the mean TFO on the same positions were 6.58±2.27, 4.27±1.90, 3.44±1.96, and 2.38±1.91 mm. On the mortise view, the mean TFCS in NS, DF10, and DF20 positions were 3.62±0.88, 4.08±0.86, and 3.88±0.97 mm and the mean TFO on the same positions were 3.57±2.13, 2.31±1.77, and 3.57±2.14 mm. The reliabilities in all positions except TFCS on some positions were excellent. No measurement was significantly different between females and males except TFO in NS on mortise view (p=0.006) and DF10 on AP view (p=0.032).
Conclusion
Increase of TFCS and decrease of TFO on AP view reflects syndesmosis change from NS to DF20 on standing. Clinically, the effect of weight-bearing and reliability of TFO should be considered.

Keyword

Tibiofibular syndesmosis; Tibiofibular clear space; Tibiofibular overlap; Syndesmotic injuries; Ankle sprain

Figure

• 

  Fig. 1 Measurements made on the anteroposterior view of the ankle at 1 cm above the plafond. (A) Measuring tibiofibular clear space and tibiofibular overlap on the anteroposterior view of standard radiograph in standing position, (B) its schematic drawing, and (C) cross-sectional schematic drawing matched with landmarks on panel B. L: lateral border of fibula, A: anterior tibial tubercle, M: medial border of fibula, P: posterior tibial tubercle, I: floor of incisura fibularis. All landmarks on panel C were added with superscript apostrophe to match landmarks on panel B.

• 

  Fig. 2 Footholds for 10° and 20° ankle dorsiflexion. Left foothold is for 10° and right one for 20° in each image. (A) View from above. Blue footprints mean neutral position and green mean 15° internal rotation. (B) Sideview.

• 

  Fig. 3 Regression analysis of various ankle position: neutral in non-standing (NS) and standing (S) and dorsiflexion 10° (DF10) and 20° (DF20) in standing position of standard radiograph. (A) Tibiofibular clear space (TFCS) on the anteroposterior (AP) view. Coefficient of determination (linear)=0.042. (B) Tibiofibular overlap (TFO) on the AP view. Coefficient of determination (quadratic)=0.368. (C) TFCS on the mortise view. Coefficient of determination (quadratic)=0.041. (D) TFO on the mortise view. Coefficient of determination (quadratic)=0.081. (E) TFCS on the AP view excluding NS position. Coefficient of determination (quadratic)=0.045.

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