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,Foot and Ankle Surgery

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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
Foot and Ankle Surgery ( IF 1.9 ) Pub Date : 2022-05-25 , DOI: 10.1016/j.fas.2022.05.003
Grégoire Rougereau ₁ , Tristan Langlais ₂ , Marie Vigan ₃ , Alexandre Hardy ₄ , Raphaël Vialle ₅ , Thibault Marty-Diloy ₆ , Adeline Cambon-Binder ₇

Affiliation

Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France.
Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Toulouse University, Department of Pediatric Orthopedic Surgery, Children's Hospital, Purpan, Toulouse, France.
Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France.
Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France.
Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France.
Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France.
Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France.

Background

Aims 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.

Methods

Both 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.

Results

The 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.

Conclusion

The 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.

中文翻译：

通过剪切波弹性成像对健康年轻人进行踝关节韧带联合生物力学评估：评估测量的可靠性和准确性以及正常走廊的定义

背景

本研究的目的是： 1/ 评估一组健康成年志愿者在中立位、背屈位和跖屈位的前下胫腓韧带 (AITFL) 和远端骨间膜 (DIOM) 的剪切波速度 (SWS) 特性; 2/ 评估这些测量的可靠性和可重复性。

方法

通过剪切波弹性成像 (SWE) 对 20 名健康患者（10 名女性/10 名男性）的双脚踝进行分析，这些患者站在铰链支撑上，脚踝处于中立、20° 背屈和 30° 跖屈位置。AITFL 和 DIOM 的刚度通过 SWS 测量进行评估。

结果

AITFL 和 DIOM 的 SWS 在跖屈位置最小（分别为 4.28 m/s [2.65–5.11] 和 3.35 m/s [1.69–4.55]）。两个韧带在中立位时显着增加（分别为 4.69 m/s [3.53–5.71] 和 3.81 m/s [1.91–4.74]；p < 0.0001），并在背屈时达到最大值（6.58 m/s分别为 [5.23–8.34] 和 4.79 m/s [3.07–6.19]；p < 0.0001）。无论位置如何，每个韧带之间都没有相关性。AITFL 的 SWS 独立于所分析的人口统计特征。DIOM 的 SWS 与背屈高度 (ρ = -0.35; p = 0.03) 和跖屈高度 (ρ = -0.37; p = 0.02) 呈负相关。女性性别与中立 (p = 0.005)、背屈 (p = 0.003) 和跖屈 (p = 0.001) 位置的 DIOM SWS 增加有关。而且，足部形态（足弓、后足前部偏差）不影响 AITFL 和 DIOM SWS。观察者间和观察者内的测量结果都很好或非常好。