Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter?

Delaram Shakoor, Greg M. Osgood, Michael Brehler, Wojciech B. Zbijewski, Cesar de Cesar Netto, Babar Shafiq, Jakrapong Orapin, Gaurav Thawait, Lew C. Shon, Shadpour Demehri

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective: To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles. Materials and methods: In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included. Twelve standardized syndesmosis measurements at two axial planes (10 mm above the tibial plafond and 5 mm below the talar dome) were obtained by two expert readers using a custom CBCT viewer with the capability for geometric measurements between user-identified anatomical landmarks. Inter-reader reliability between two readers was obtained using the intra-class correlation coefficient (ICC). We compared the WB and NWB measurements using paired t test. Results: Significant agreement was observed between two readers for both WB and NWB measurements (p <0.05). ICC values for WB and NWB measurements had a range of 50–95 and 31–71 respectively. Mean values of the medial clear space on WB images (1.75, 95% confidence interval [95% CI]: 1.6, 1.9) were significantly lower than on NWB images (2.05, 95% CI: 1.8, 2.2) measurements (p <0.001). There was no significant difference between the remaining WB and NWB measurements. Conclusion: Measurements obtained from WB images are reliable. Except for the medial clear space, no significant difference in syndesmotic measurements were observed during the WB mode of CBCT acquisition, implying that the tibio-fibular relationship remains unchanged when the physiological axial weight-bearing load is applied.

Original languageEnglish (US)
Pages (from-to)583-594
Number of pages12
JournalSkeletal Radiology
Issue number4
StatePublished - Apr 1 2019


  • Cone-beam CT
  • Medial clear space
  • Normal ankles
  • Syndesmosis
  • Weight-bearing

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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