ArticleFrontiers in medicine2026
Incisura groove depth is associated with reduced rotational fibular displacement after syndesmotic injury: cadaveric validation of an automated three-dimensional incisura morphometric pipeline.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The tibial incisura provides the osseous constraint in which the fibula is seated at the distal tibiofibular syndesmosis. The morphology of this constraint varies substantially between individuals, making it plausible that incisura geometry modulates fibular displacement under a given injury pattern and the individual risk of injury under comparable mechanisms. Reproducible quantification of three-dimensional incisura morphometry is a prerequisite for testing these hypotheses. This study aimed to develop and validate an automated three-dimensional morphometric toolbox for the tibial incisura, and secondarily to test the resulting outputs in a controlled cadaveric model of syndesmotic injury. Methods: An automated MATLAB toolbox was developed to compute eight three-dimensional morphometric parameters of the incisura from CT-derived data. The toolbox was evaluated on 34 cadaveric tibiae from 17 matched specimen pairs for reproducibility across repeat acquisitions and for bilateral reliability. Under a cadaveric protocol of repeat scanning before and after complete four-ligament syndesmotic sectioning, outputs were correlated with fibular displacement magnitude from paired six-degree-of-freedom kinematics. Results: All eight toolbox outputs showed no significant difference between pre- and post-sectioning acquisitions of the same bone, demonstrating reproducibility across repeat CT acquisitions. Bilateral reliability was good for all eight outputs (ICC ≥ 0.75), with seven exceeding 0.80. Four of the six outputs tested against displacement were significantly negatively associated with the magnitude of external rotation: mean groove depth ( Conclusion: The incisura metrics toolbox provides reproducible, bilaterally reliable, and fully automated three-dimensional morphometric characterization of the tibial incisura fibularis from CT-derived surface meshes, supplying the methodological foundation required for prospective clinical study of incisura morphology. As a secondary exploratory finding, larger osseous constraint envelopes were associated with reduced rotational fibular displacement under controlled cadaveric sectioning, while morphology did not modulate translational displacement, supporting the construct validity of the pipeline and indicating that incisura morphometry is a candidate input to future diagnostic and predictive injury models.
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