A quantitative assessment of the anterior tibiofibular gap with and without weight-bearing in healthy adults: An ultrasound-based study

Abstract

Background

Difficulties in the accurate evaluation of tibiofibular clear space in plain radiographs are diagnostic problems in the clinical setting of syndesmosis injury. This study aimed to quantify the anterior tibiofibular gap (ATFG) with weight-bearing using ultrasonography.

Methods

In total, 32 healthy adults (16 men and 16 women) with 64 feet participated in this cross-sectional study. The ATFG was measured along the anterior inferior tibiofibular ligament for a US assessment conducted in both sitting and standing postures. The ankle joint was set on the tilt table at four different angles as follows: plantar flexion, 20° (P20); neutral position (N); dorsiflexion, 20° (D20); and dorsiflexion, 20°+ external rotation, 30° (D20ER30). The ankle joint position, sex, and side-to-side values were compared with and without weight-bearing.

Results

Under all ankle angle conditions, the ATFG was wider in the standing posture than in the sitting posture (p < 0.001). In both sitting and standing postures, the ATFG widened with increasing dorsiflexion angle, eventually reaching a maximum at D20ER30. The widening ratio (D20ER30/N) in the standing posture was higher in women than in men (p < 0.05). No statistical differences were identified side-to-side differences in the ATFG.

Conclusions

Ultrasound measurements for identifying unphysiological increases in ATFG with weight bearing, especially given the side-to-side differences, may provide a means for quantitatively assessing syndesmosis injury in a clinical setting. Further research is warranted to clarify direct attribution as a clinical diagnostic utility of the ATFG measurements for syndesmosis injuries.