Background: Despite the common occurrence of syndesmotic injuries in ankle trauma, the distal tibiofibular relationship remains poorly understood. The aim of this study was to evaluate the anatomical impact of ankle sagittal positioning on the tibiofibular relationship in intact ankles by using a validated magnetic resonance imaging (MRI)-based measurement system.
Methods: In this radiologic study, 34 healthy volunteers underwent a series of ankle MRIs with the ankle stabilized in 3 positions: neutral position (NP), dorsiflexion (DF), and plantarflexion (PF). Using a previously validated measurement system, 6 fixed translational measurements and 2 fixed angles were recorded on each MRI and compared using paired t tests.
Results: When comparing PF to DF, the anterior distance between the tibial incisura and the fibula varied from 2.5 mm to 3.9 mm ( P < .001), respectively. The middle distance between the tibial incisura and the fibula varied from 1.5 mm to 2.6 mm ( P < .001). Fibular angle varied from 8.7 degrees to 7.8 degrees of internal rotation ( P = .046), respectively. When comparing NP to DF, only the anterior distance was found to be significantly different, varying 0.4 mm ( P < .002).
Conclusions: Ankle dorsiflexion leads to an increase in external rotation and lateral translation of the fibula. These changes could be measured on MRI using a validated measurement system. Ankle motion did have an impact on the distal tibiofibular relationship and should be considered in studies pertaining to syndesmosis imaging.
Clinical relevance: This is the first in vivo study demonstrating the impact of sagittal ankle position on the distal tibiofibular relationship in an uninjured ankle. Our findings also support the practice of placing the ankle in dorsiflexion when fixing a disrupted syndesmosis.
Level of evidence: Level III, comparative study.
Keywords: MRI; dorsiflexion; neutral position; normal values; plantarflexion; syndesmosis.