Variation of Syndesmosis Anatomy With Growth

Abstract

Syndesmosis injury is common in trauma and in the sport medicine population. Diagnosis and treatment of this pathology is controversial in adult population and almost unknown in a growing and immature ankle. The objective of this study was to describe the relationship between the distal tibia and fibula in immature, growing, and mature children. A retrospective imaging study was performed on ankle magnetic resonance images (MRI), which were divided into 3 groups according to age: immature, growing, or mature. The syndesmosis anatomy was described in 3 planes following an established measurement system. The measurement system was also validated (intraobserver and interobserver reproducibility) on a subgroup of 30 MRIs with 4 surgeons. The measurement system, previously described on CT scans, is valid when used on MRIs. The mediolateral translation significantly increases with growth and external rotation of fibula decreases. The anteroposterior position is also significantly different between groups but the ratios are similar. This study reported differences in distal tibiofibular relationship in a growing population. This information will be crucial in future development of diagnostic and follow-up criteria of syndesmosis injury. It also presented a valid and precise measurement system to describe syndesmotic anatomy in 3 planes. Level IV.