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Arthroscopic coronal plane syndesmotic instability has been over-diagnosed

PURPOSE: Ankle arthroscopy is widely used for diagnosis of syndesmotic instability, especially in subtle cases. To date, no published article has systematically reviewed the literature in aggregate to understand which instability values should be used intraoperatively. The primary aim was to systema...

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Autores principales: Hagemeijer, Noortje C., Elghazy, Mohamed Abdelaziz, Waryasz, Gregory, Guss, Daniel, DiGiovanni, Christopher W., Kerkhoffs, Gino M. M. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862212/
https://www.ncbi.nlm.nih.gov/pubmed/32451623
http://dx.doi.org/10.1007/s00167-020-06067-5
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author Hagemeijer, Noortje C.
Elghazy, Mohamed Abdelaziz
Waryasz, Gregory
Guss, Daniel
DiGiovanni, Christopher W.
Kerkhoffs, Gino M. M. J.
author_facet Hagemeijer, Noortje C.
Elghazy, Mohamed Abdelaziz
Waryasz, Gregory
Guss, Daniel
DiGiovanni, Christopher W.
Kerkhoffs, Gino M. M. J.
author_sort Hagemeijer, Noortje C.
collection PubMed
description PURPOSE: Ankle arthroscopy is widely used for diagnosis of syndesmotic instability, especially in subtle cases. To date, no published article has systematically reviewed the literature in aggregate to understand which instability values should be used intraoperatively. The primary aim was to systematically review the amount of tibiofibular displacement that correlates with syndesmotic instability after a high ankle sprain. A secondary aim is to assess the quality of such research. METHODS: Systematic searches of EMBASE (Ovid) and MEDLINE via PubMed, CINAHL, Web of Science, and Google Scholar were used. Inclusion criteria: studies that arthroscopically evaluated the fibular displacement at various stages of syndesmotic ligament injury. Two reviewers independently extracted data and assessed methodological quality using the Anatomical Quality Assessment (AQUA) Tool and methodological index for non-randomized studies (MINORS). RESULTS: Eight cadaveric studies and three clinical studies were included for review. All studies reported displacement in the coronal plane, four studies reported in the sagittal plane, and one reported findings in the rotational plane. Four cadaveric studies had a similar experimental set up and the weighted mean associated with instability in the coronal plane could be calculated and was 2.9 mm at the anterior portion of the distal tibiofibular joint and 3.4 mm at the posterior portion. Syndesmotic instability in the sagittal plane is less extensively studied, however available data from a cadaveric study suggests thresholds of 2.2 mm of posterior fibular translation when performing an anterior to posterior hook test and 2.6 mm of anterior fibular translation when performing a posterior to anterior hook test. CONCLUSIONS: The results have concluded that the commonly used 2.0 mm threshold value of distal tibiofibular diastasis may lead to overtreatment of syndesmotic instability, and that using threshold values of 2.9 mm measured at the anterior portion of the incisura and 3.4 mm at the posterior portion may represent better cut off values. Given the ready availability of 3 mm probes among standard arthroscopic instrumentation, at the very least surgeons should use 3 mm in lieu of 2 mm probes intraoperatively. LEVEL OF EVIDENCE: IV.
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spelling pubmed-78622122021-02-11 Arthroscopic coronal plane syndesmotic instability has been over-diagnosed Hagemeijer, Noortje C. Elghazy, Mohamed Abdelaziz Waryasz, Gregory Guss, Daniel DiGiovanni, Christopher W. Kerkhoffs, Gino M. M. J. Knee Surg Sports Traumatol Arthrosc Ankle PURPOSE: Ankle arthroscopy is widely used for diagnosis of syndesmotic instability, especially in subtle cases. To date, no published article has systematically reviewed the literature in aggregate to understand which instability values should be used intraoperatively. The primary aim was to systematically review the amount of tibiofibular displacement that correlates with syndesmotic instability after a high ankle sprain. A secondary aim is to assess the quality of such research. METHODS: Systematic searches of EMBASE (Ovid) and MEDLINE via PubMed, CINAHL, Web of Science, and Google Scholar were used. Inclusion criteria: studies that arthroscopically evaluated the fibular displacement at various stages of syndesmotic ligament injury. Two reviewers independently extracted data and assessed methodological quality using the Anatomical Quality Assessment (AQUA) Tool and methodological index for non-randomized studies (MINORS). RESULTS: Eight cadaveric studies and three clinical studies were included for review. All studies reported displacement in the coronal plane, four studies reported in the sagittal plane, and one reported findings in the rotational plane. Four cadaveric studies had a similar experimental set up and the weighted mean associated with instability in the coronal plane could be calculated and was 2.9 mm at the anterior portion of the distal tibiofibular joint and 3.4 mm at the posterior portion. Syndesmotic instability in the sagittal plane is less extensively studied, however available data from a cadaveric study suggests thresholds of 2.2 mm of posterior fibular translation when performing an anterior to posterior hook test and 2.6 mm of anterior fibular translation when performing a posterior to anterior hook test. CONCLUSIONS: The results have concluded that the commonly used 2.0 mm threshold value of distal tibiofibular diastasis may lead to overtreatment of syndesmotic instability, and that using threshold values of 2.9 mm measured at the anterior portion of the incisura and 3.4 mm at the posterior portion may represent better cut off values. Given the ready availability of 3 mm probes among standard arthroscopic instrumentation, at the very least surgeons should use 3 mm in lieu of 2 mm probes intraoperatively. LEVEL OF EVIDENCE: IV. Springer Berlin Heidelberg 2020-05-25 2021 /pmc/articles/PMC7862212/ /pubmed/32451623 http://dx.doi.org/10.1007/s00167-020-06067-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Ankle
Hagemeijer, Noortje C.
Elghazy, Mohamed Abdelaziz
Waryasz, Gregory
Guss, Daniel
DiGiovanni, Christopher W.
Kerkhoffs, Gino M. M. J.
Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title_full Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title_fullStr Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title_full_unstemmed Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title_short Arthroscopic coronal plane syndesmotic instability has been over-diagnosed
title_sort arthroscopic coronal plane syndesmotic instability has been over-diagnosed
topic Ankle
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862212/
https://www.ncbi.nlm.nih.gov/pubmed/32451623
http://dx.doi.org/10.1007/s00167-020-06067-5
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