ArticleFoot & ankle international2024
The Contralateral Ankle Joint Is a Reliable Reference for Testing Syndesmotic Stability Using Bilateral External Torque CT.
Article in Foot & ankle international, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Bilateral External Rotation Torque CT Remains Reliable in Syndesmotic Assessment Despite Lateral Ligament Injury, but Reveals Increased Tibiotalar Rotational Instability.Foot & ankle orthopaedics · 2026Article
- Effects of graded talar external rotation on distal tibial articular surface stress and contact pressure: a finite element study.Frontiers in sports and active living · 2026Article
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6 authors.
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Abstract
backgroundSubtle chronic or latent instabilities are difficult to delineate with currently available diagnostic modalities and do not allow assessment of ligamentous functionality. The noninvasive bilateral external torque computed tomography (CT) was able to reliably detect syndesmotic lesions in a cadaveric study. The aim of the study was to test the external torque device in young, healthy subjects at 3 different torque levels and to demonstrate comparability with the contralateral side.
methodsTen healthy subjects without history of injury or surgery to the ankle joint were enrolled in this cross-sectional study. Four CT scans were performed. During the scans, the lower legs and feet were placed in an external torque device with predefined external rotation torques of 0, 2.5, 5, and 7.5 Nm. Five different radiographic measures of syndesmotic stability were measured: anterior distance (AD), tibiofibular clear space (TCS), posterior distance (PD), external rotation (ER), and β angle.
resultsWith increasing external torque, slight increases in AD, ER, and β angle were observed, whereas TCS and PD decreased slightly. Large absolute differences were found between the healthy subjects for all measured parameters, regardless of the external torque applied. Differences from the contralateral side using the same external torque were minimal for all parameters, but smallest for AD with a maximum difference of 0.5 mm.
conclusionUsing the healthy contralateral ankle joint is appropriate for assessing syndesmotic stability based on minimal intraindividual side differences using the external torque device. Side differences >0.5 mm in AD and >0.9 mm in PD may be considered abnormal and may indicate significant instability of the syndesmosis. However, future studies are needed to define definitive cutoff values for relevant side differences in acute and chronic syndesmotic instability to guide clinicians in their treatment decisions.
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