Diagnosing syndesmotic instability in ankle fractures

Table 1 Arthroscopic assessment of distal tibiofibular syndesmotic stability

Study, yr	Patients	Test
Takao et al[39], 2001	38 Weber B fractures, 26 males, 40 yr	Arthroscopic anatomical examination of anterior tibiofibular ligament, the posterior tibiofibular ligament, and the transverse tibiofibular ligament. The interosseous ligament and membrane were not assessed
		Syndesmotic disruptions were diagnosed in 16 of 38 patients (42%) by AP radiography, in 21 of 38 patients (55%) by mortise radiography, and in 33 of 38 patients (87%) by ankle arthroscopy
Sri-Ram et al[37], 2005	1 Maisonneuve ankle fracture, image intensifier showed no syndesmotic diastasis	> 2 mm movement in between the tibia and fibula during arthroscopy
Lui et al[38], 2005	53 Weber B and C fractures, 35 yr, without radiographic evidence of frank syndesmosis diastasis	≥2 mm displacement of lateral malleolus in coronal or sagittal plane. Displacement of anterior border of the lateral malleolus at least 2 mm more than displacement of the posterior border of the lateral malleolus
		16 cases had positive intraoperative stress radiographs; 35 cases had positive arthroscopic findings of syndesmosis diastasis, including various combinations of coronal, sagittal, and rotational planes of instability
Ono et al[40], 2004	105 ankle fractures, 59 males, 46 yr	Distal tibiofibular joint instability was detected by a squeeze test under fluoroscopy or by residual, arthroscopically observed diastasis of the joint
		Persistent instability of the distal tibiofibular joint, which was detected under fluoroscopy and arthroscopy in 8 patients
Takao et al[36], 2003	52 acute ankle injuries, 31 males, 35 yr	Arthroscopic anatomical assessment of AITFL and the PITFL, transverse ligament, interosseous ligament and membrane were not assessed
		The accuracy of AP radiography, mortise radiography and MRI was compared with arthroscopy for the diagnosis of a tear of the tibiofibular syndesmosis
Hintermann et al[41], 2002	148 chronic ankle instabilities, 38 males,34 yr	Arthroscopic anatomical assessment of AITFL, PITFL, and the transverse ligament