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14.11.2022 | Technical Report

Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete

verfasst von: Tanner Campbell, Anthony Mok, Megan R. Wolf, Armin Tarakemeh, Brian Everist, Bryan G. Vopat

Erschienen in: Skeletal Radiology

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Abstract

Objective

We aim to present a novel imaging technique utilizing weight-bearing CT with syndesmotic stress to identify subtle, unstable syndesmotic injuries. We illustrate this with a case presentation of such an injury in an elite athlete that ultimately required operative fixation.

Materials and methods

In order to perform an augmented stress weightbearing CT, the patient is in the standing position, feet facing forward, and with weight distributed equally. The patient is then coached to internally rotate the shin and knee. This places an external rotational moment on the TFS due to the planted foot and ankle. The augmented stress images undergo 3D reconstruction and post-processing to render coronal and sagittal images. These are subsequently compared to standard, conventional weightbearing CT images performed without the external rotation stress.

Results

We illustrate this technique by presenting a case in which a 21-year-old collegiate athlete sustained a Grade II syndesmotic injury, diagnosed by MRI and clinical exam without evidence of instability by standard weightbearing CT or weightbearing radiographs. After undergoing the augmented stress weightbearing CT, the instability was noted. This prompted subsequent operative fixation and ultimately return to sport.

Conclusion

We propose this technique for diagnosing unrecognized, subtle dynamically unstable syndesmosis injuries where clinical suspicion persists despite negative imaging, particularly in the elite athlete.
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Metadaten
Titel
Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete
verfasst von
Tanner Campbell
Anthony Mok
Megan R. Wolf
Armin Tarakemeh
Brian Everist
Bryan G. Vopat
Publikationsdatum
14.11.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-022-04229-9

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