title: Chronic tibiofibular syndesmosis injury: the diagnostic efficiency of magnetic resonance imaging and comparative analysis of operative treatment.
abstract: BACKGROUND
  The purpose of this study was to determine the sensitivity and specificity of MRI in chronic syndesmosis injury by comparing the arthroscopic findings with MRI findings and to suggest therapeutic guidelines of syndesmotic fixation.
  
  
  METHODS
  Between January, 2003, and January, 2004, 20 patients were diagnosed with chronic syndesmosis injury according to syndesmosis widening (>2 mm) on arthroscopic examination. The average age of the patients was 32 years. The minimum followup was 22 (22 to 30) months. MRI was obtained in all patients. For evaluating the therapeutic role of syndesmotic fixation, we separated the patients into two groups (with and without transfixation) and compared preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and patient satisfaction.
  
  
  RESULTS
  The sensitivity, specificity, and accuracy of MRI were 90.0%, 94.8%, and 93.4%, respectively. In group I with syndesmotic fixation, the AOFAS ankle-hindfoot scale improved from 52 to 87, and in group II without syndesmotic fixation the score improved from 63 to 90 at last followup, which showed no statistically significant difference (p = 0.6453). Also, patient satisfaction showed no difference between the two groups.
  
  
  CONCLUSIONS
  MRI showed high sensitivity, specificity, and accuracy under the criteria we proposed, and we recommend it as the main diagnostic tool for diagnosing a chronic syndesmosis injury. These findings might suggest that pain is mainly caused by hypertrophy and impingement of the soft tissue in the distal tibiofibular joint. Arthroscopic debridement alone can be recommended if the distal tibiofibular chronic syndesmosis injury is not combined with medial ankle instability and lateral displacement of the talus.
authors: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Seung Hwan
authors: SH
authors: Han
authors: Jin Woo
authors: JW
authors: Lee
authors: Sungjun
authors: S
authors: Kim
authors: Jin-Suck
authors: JS
authors: Suh
authors: Yoon Rak
authors: YR
authors: Choi
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis* / Q000601:surgery*; D001182:Arthroscopy; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D012680:Sensitivity and Specificity