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Cadaveric Diagnostic Study of Subtle Syndesmotic Instability Using a 3-Dimensional Weight-Bearing CT Distance Mapping
Cesar de Cesar Netto1,2, Nacime Salomão Barbachan Mansur1,2, Grayson Talaski2
1Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
The Journal of Bone and Joint Surgery. American Volume
|December 19, 2024
Summary
A new 3D weight-bearing computed tomography (WBCT) algorithm accurately detects subtle syndesmotic instability in cadavers. This method shows promise for improving diagnosis of ankle injuries and preventing arthritis.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomechanics
Background:
- Syndesmotic instability diagnosis is challenging and can lead to ankle arthritis.
- A 3D weight-bearing computed tomography (WBCT) distance mapping algorithm was developed to detect subtle instability.
Purpose of the Study:
- To evaluate a 3D WBCT distance mapping algorithm for detecting subtle syndesmotic instability.
- To test the algorithm's accuracy in a cadaveric model with induced syndesmotic injury.
Main Methods:
- Nineteen cadaveric specimens underwent WBCT scanning in normal and injured states.
- Simulated axial weight-bearing was applied, and syndesmotic distances were measured using the 3D algorithm.
- Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated.
Main Results:
- The algorithm detected significant syndesmotic widening in injured specimens compared to controls.
- Average relative syndesmotic widening ranged from 2.9% to 16.9% at various proximal distances.
- Diagnostic accuracy was highest in the anterior syndesmosis, with AUC values up to 83.0%.
Conclusions:
- The 3D WBCT distance mapping algorithm accurately detects subtle syndesmotic instability under axial load in a cadaveric model.
- Further validation in patients with suspected traumatic syndesmotic instability is recommended.
- This algorithm may optimize diagnosis and treatment decisions for ankle injuries.
