Ankle syndesmosis biomechanical evaluation by shear-waves elastography in healthy young adults: Assessment of the reliability and accuracy of the measurements and definition of a corridor of normality |
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| Affiliation: | 1. Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France;2. Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France;3. Toulouse University, Department of Pediatric Orthopedic Surgery, Children’s Hospital, Purpan, Toulouse, France;4. Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France;5. Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France;6. The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France;7. Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France;1. Sheffield Teaching Hospitals NHS Foundation Trust, UK;2. ZNA Middelheim Antwerpen , Belgium;1. Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey;2. Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey;1. Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University, Tuebingen, Germany;2. Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany;3. Department of Psychosomatic Medicine, University Medical Center Regensburg, Regensburg, Germany |
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| Abstract: | BackgroundAims of this study were: 1/ to evaluate the shear wave speed (SWS) properties of the anteroinferior tibiofibular ligament (AITFL) and the distal interosseous membrane (DIOM) in neutral, dorsal flexion and plantar flexion positions in a cohort of healthy adult volunteers; 2/ to assess the reliability and reproducibility of these measurements.MethodsBoth ankles were analyzed by shear wave elastography (SWE) in 20 healthy patients (10 females/10 males) standing on a hinge support with their ankles in neutral, 20° dorsal flexion and 30° plantar flexion positions. Stiffness of AITFL and DIOM was evaluated by SWS measurement.ResultsThe SWS of AITFL and DIOM were minimal in the plantar flexion position (4.28 m/s [2.65–5.11] and 3.35 m/s [1.69–4.55], respectively). It increased significantly for both ligaments in neutral position (4.69 m/s [3.53–5.71] and 3.81 m/s [1.91–4.74], respectively; p < 0.0001), and reached their maximum values in dorsal flexion (6.58 m/s [5.23–8.34] and 4.79 m/s [3.07–6.19], respectively; p < 0.0001). There was no correlation between each ligament regardless the positions. SWS of AITFL was independent of demographic characteristics analyzed. SWS of DIOM was negatively correlated with height in dorsal flexion (ρ = ?0.35; p = 0.03) and in plantar flexion (ρ = ?0.37; p = 0.02). Female gender was associated with increased DIOM SWS in neutral (p = 0.005), dorsal flexion (p = 0.003), and plantar flexion (p = 0.001) positions. Moreover, foot morphology (foot arch, hind foot frontal deviation) did not impact AITFL nor DIOM SWS. Inter- and intra-observer measurements were all good or excellent.ConclusionThe AITFL and DIOM, stabilizers of the distal tibiofibular syndesmosis, increase in stiffness while dorsal flexion increases. This study describes a reliable and reproducible protocol to assess their stiffness by SWE, and defines a corridor of normality. |
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| Keywords: | Anatomy Elasticity imaging techniques Elastography Ankle Syndesmosis |
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