MedStar Orthopaedic Investigators Evaluate Subtle Ankle Injury

Woman sitting in a wooden chair focused on feet and ankles

Researchers at MedStar Union Memorial Hospital (MUMH) have published the results of a laboratory investigation that used a novel diagnostic tool for diagnosing subtle injury to the ankle in cases of ankle sprain.

“Arthroscopic Correlates of Subtle Syndesmotic Injury” was published recently in Foot & Ankle International, the research publication of the American Orthopaedic Foot and Ankle Society. The investigators included Gregory Guyton, MD; resident Kenneth DeFontes, MD; fellow Cameron Barr, MD; laboratory director Brent Parks, MSc; and medical editor and writer, Lyn Camire, MA, ELS. The purpose of this research was to determine whether the extent of the ankle syndesmosis correlates with an injury to soft tissues in the ankle. Previous studies had assumed that a certain amount of opening in the syndesmosis indicated injury to these tissues, but no study had established that criterion using objective measures. Therefore, surgical decisions were potentially being made based on an unproven assumption.

The syndesmosis is a slightly movable fibrous joint that joins the tibia and fibula with connective tissue. The opening of the syndesmosis beyond the normal range indicates disruption of one or more of the surrounding ligaments. Extensive syndesmotic disruption is readily diagnosed using radiography, but subtle injury is difficult to discern clinically.

The study determined that passage of a 3-mm probe into the syndesmosis opening was the most likely criterion upon which further clinical investigation of ligament injury should be based. This size of the opening is larger than that previously considered to represent subtle ligament injury. This study represents one step forward in the process of treating syndesmosis injury. Future studies are needed to establish clinical data correlating specific anatomic lesions identified by spherical probe passage.

The Department of Orthopedics at MUMH is a growing group of fellowship-trained physicians who specialize in diagnosis and treatment of musculoskeletal pain or injury. These specialists are leading research that will contribute to improvements in patient care now and in the future.

Foot & Ankle International, 2017. DOI:10.1177/1071100716688198