000			04198nam a22004577a 4500
266			_d2024-01-22
008			240122s20232023xxu||||| |||| 00| 0 eng d
022			_a1071-1007
024			_a10.1177/10711007231205576 [doi]
040			_aOvid MEDLINE(R)
099			_a37902238
245			_aNormal Values for Distal Tibiofibular Syndesmotic Space With and Without Subject-Driven External Rotation Stress.
251			_aFoot & Ankle International. :10711007231205576, 2023 Oct 30
252			_aFoot Ankle Int. :10711007231205576, 2023 Oct 30
253			_aFoot & ankle international
260			_c2023
260			_fFY2024
260			_p2023 Oct 30
265			_saheadofprint
265			_tPublisher
501			_aAvailable online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
520			_aBACKGROUND: The diagnosis and treatment of distal tibiofibular syndesmosis (DTFS) injury can be challenging, especially in cases of subtle instability that may be masked on 2-dimensional conventional radiographs. Weightbearing computed tomography (WBCT) has recently emerged as a useful diagnostic tool allowing direct assessment of distal tibiofibular area widening. The purpose of the current study was to examine and report normal threshold values for DTFS area measurements in a cohort of healthy volunteers, assessing the ankles in natural weightbearing position and under subject-driven external rotation stress.
520			_aCONCLUSION: This study presents normal values and range for DTFS area calculation. In uninjured ankles with expected intact ligaments, subject-driven external rotation stress did not result in significant widening of the DTFS space as imaged on with WBCT.
520			_aLEVEL OF EVIDENCE: Level II, cross-sectional study.
520			_aMETHODS: In this prospective study, we enrolled 25 healthy volunteers without a history of DTFS injury or high ankle sprain, previous foot and ankle surgery, or current ankle pain. Subjects with any prior ankle injuries were excluded. Study participants underwent bilateral standing nonstress and external rotation stress WBCT scans. The DTFS area (mm2) was semiautomatically quantified on axial-plane WBCT images 1 cm proximal to the apex of the talar dome using validated software. Syndesmosis area values were compared between "unstressed" and "stressed" ankles, as well as left and right ankles. Statistical analysis was performed using independent t tests/Wilcoxon analysis with statistical significance defined as P <.05.
520			_aRESULTS: The study cohort consisted of 50 ankles in 25 patients (12 males, 48%) with a mean age of 28.7 +/- 9.3 years. In the unstressed ankle, the mean pooled DTFS area was determined to be 103.8 + 20.8 mm2. The mean syndesmosis area of unstressed left ankles (104.2 + 19.5 mm2) was similar to unstressed right ankles (109.2 + 17.2 mm2) in the cohort (P = .117). With external rotation stress, the DTFS area of left ankles (mean difference -0.304 mm2, CI -12.1 to 11.5; P = .082), right ankles (mean difference -5.5 mm2, CI 16.7-5.7; P = .132), and all ankles (mean difference -2.9 mm2, CI -10.8 to 5.1; P = .324) remained similar.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Union Memorial Hospital
656			_aFoot and Ankle Surgery Fellowship
656			_aMedStar Georgetown University Hospital/MedStar Washington Hospital Center
656			_aOrthopaedic Surgery Residency
657			_aJournal Article
700			_aBarbachan Mansur, Nacime Salomao _bMUMH _cFoot and Ankle Surgery Fellowship _dMD, PhD
700			_aDay, Jonathan _bMGUH _cOrthopaedic Surgery Residency _dMD
790			_aShamrock A, Den Hartog TJ, Dowley K, Day J, Barbachan Mansur NS, Carvalho KAM, de Cesar Netto C, O'Malley M
856			_uhttps://dx.doi.org/10.1177/10711007231205576 _zhttps://dx.doi.org/10.1177/10711007231205576
858			_yBarbachan Mansur, Nacime Salomao _uhttps://orcid.org/0000-0003-1067-727X _zhttps://orcid.org/0000-0003-1067-727X
858			_yDay, Jonathan _uhttps://orcid.org/0000-0003-1106-3042 _zhttps://orcid.org/0000-0003-1106-3042
942			_cART _dArticle
999			_c13871 _d13871