Syndesmotic and Deltoid Injuries: Companions or Coincidences
Background: Syndesmotic complex injuries are supposedly associated with injuries to the deltoid ligament (DL) complex. Several syndesmosis classifications take DL injuries into account when rating the stability of the syndesmotic injury. Still, no study has yet assessed the frequency and severity of...
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| Veröffentlicht in: | Foot & ankle international 2024-11, Vol.45 (11), p.1239-1246 |
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| creator | Gaube, Federico Paolo Maßen, Felix Polzer, Hans Böcker, Wolfgang Reidler, Paul Saller, Maximilian Michael Baumbach, Sebastian Felix Hesse, Nina |
| description | Background:
Syndesmotic complex injuries are supposedly associated with injuries to the deltoid ligament (DL) complex. Several syndesmosis classifications take DL injuries into account when rating the stability of the syndesmotic injury. Still, no study has yet assessed the frequency and severity of DL injuries in unstable syndesmotic injuries. The aim of this retrospective cohort study was to assess both the severity of the syndesmotic and DL injury in patients undergoing surgery for an unstable syndesmotic injury.
Methods:
The integrity of the syndesmotic and DL complex of 37 patients were assessed on MRI by 2 musculoskeletal radiologists. Eligible were adult patients with an acute, isolated, unstable syndesmotic injury (ligamentous or bony avulsions) who underwent surgery. The DL complex was classified as having 3 superficial (TNL/TSL/TCL) and 2 deep (aTTL/pTTL) components. Grade 0 indicated an intact ligament; grade I showed a periligamentous edema; grade II a partial tear presenting as laxity, irregular contour, or partial discontinuity with concomitant hyperintense signaling; grade III a complete tear; or grade IV in case of an avulsion fracture. Frequency and severity of DL injuries were assessed, and possible injury combinations analyzed using an h-cluster analysis and Mann-Whitney U test.
Results:
Mean severity (grade 0-3) was 2.6 ± 0.8 for the syndesmotic complex and 1.6 ± 1.1 for the DL (superficial 1.5 ± 1.1, deep 1.6 ± 1.1). Seven patients (19%) had no (n = 3; 8%) or minor (grade 1: n = 4; 11%) DL injuries. Overall, 2 different patient clusters and 4 separate ligament clusters were identified.
Conclusion:
Unstable syndesmotic injuries can occur isolated or with an accompanying DL injury. There appears to be a great heterogeneity between the severity of syndesmotic and deltoid ligament injuries. |
| doi_str_mv | 10.1177/10711007241274712 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11538799</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_10711007241274712</sage_id><sourcerecordid>3108392280</sourcerecordid><originalsourceid>FETCH-LOGICAL-c278t-6ea1c7f335b7222b6c31d145e5075241668fdf71690f323d93952ecac67b6f5f3</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMoVqs_wIvs0cvWTLK72YggUr8KBQ_qOaTZbE3ZTWqyK_Tfm9JaFMHTZJhn3gwPQmeARwCMXQJmABgzkgFhGQOyh46AZ1nKSlbsx3ecp2tggI5DWGAMjAI_RAPKKWCel0fo-mVlKx1a1xmVSFsld7rpnKmSiV303uhwlYxdu5TWOBsS52NnrDKVtkqHE3RQyybo020doreH-9fxUzp9fpyMb6epIqzs0kJLUKymNJ8xQsisUBQqyHKdY5bH24uirKuaQcFxTQmtOOU50Uqqgs2KOq_pEN1scpf9rNWV0rbzshFLb1rpV8JJI35PrHkXc_cpAHJaMs5jwsU2wbuPXodOtCYo3TTSatcHEXWUlBNS4ojCBlXeheB1vfsHsFhrF3-0x53znwfuNr49R2C0AYKca7FwvbdR2D-JX_AOieY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3108392280</pqid></control><display><type>article</type><title>Syndesmotic and Deltoid Injuries: Companions or Coincidences</title><source>MEDLINE</source><source>SAGE Complete</source><creator>Gaube, Federico Paolo ; Maßen, Felix ; Polzer, Hans ; Böcker, Wolfgang ; Reidler, Paul ; Saller, Maximilian Michael ; Baumbach, Sebastian Felix ; Hesse, Nina</creator><creatorcontrib>Gaube, Federico Paolo ; Maßen, Felix ; Polzer, Hans ; Böcker, Wolfgang ; Reidler, Paul ; Saller, Maximilian Michael ; Baumbach, Sebastian Felix ; Hesse, Nina</creatorcontrib><description>Background:
Syndesmotic complex injuries are supposedly associated with injuries to the deltoid ligament (DL) complex. Several syndesmosis classifications take DL injuries into account when rating the stability of the syndesmotic injury. Still, no study has yet assessed the frequency and severity of DL injuries in unstable syndesmotic injuries. The aim of this retrospective cohort study was to assess both the severity of the syndesmotic and DL injury in patients undergoing surgery for an unstable syndesmotic injury.
Methods:
The integrity of the syndesmotic and DL complex of 37 patients were assessed on MRI by 2 musculoskeletal radiologists. Eligible were adult patients with an acute, isolated, unstable syndesmotic injury (ligamentous or bony avulsions) who underwent surgery. The DL complex was classified as having 3 superficial (TNL/TSL/TCL) and 2 deep (aTTL/pTTL) components. Grade 0 indicated an intact ligament; grade I showed a periligamentous edema; grade II a partial tear presenting as laxity, irregular contour, or partial discontinuity with concomitant hyperintense signaling; grade III a complete tear; or grade IV in case of an avulsion fracture. Frequency and severity of DL injuries were assessed, and possible injury combinations analyzed using an h-cluster analysis and Mann-Whitney U test.
Results:
Mean severity (grade 0-3) was 2.6 ± 0.8 for the syndesmotic complex and 1.6 ± 1.1 for the DL (superficial 1.5 ± 1.1, deep 1.6 ± 1.1). Seven patients (19%) had no (n = 3; 8%) or minor (grade 1: n = 4; 11%) DL injuries. Overall, 2 different patient clusters and 4 separate ligament clusters were identified.
Conclusion:
Unstable syndesmotic injuries can occur isolated or with an accompanying DL injury. There appears to be a great heterogeneity between the severity of syndesmotic and deltoid ligament injuries.</description><identifier>ISSN: 1071-1007</identifier><identifier>ISSN: 1944-7876</identifier><identifier>EISSN: 1944-7876</identifier><identifier>DOI: 10.1177/10711007241274712</identifier><identifier>PMID: 39310958</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Ankle Injuries - diagnostic imaging ; Ankle Injuries - surgery ; Female ; Humans ; Joint Instability - surgery ; Ligaments, Articular - diagnostic imaging ; Ligaments, Articular - injuries ; Ligaments, Articular - surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Young Adult</subject><ispartof>Foot & ankle international, 2024-11, Vol.45 (11), p.1239-1246</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024 2024 American Orthopaedic Foot & Ankle Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c278t-6ea1c7f335b7222b6c31d145e5075241668fdf71690f323d93952ecac67b6f5f3</cites><orcidid>0000-0002-6713-4017 ; 0000-0003-3995-3071 ; 0000-0002-6287-6206</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/10711007241274712$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/10711007241274712$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39310958$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gaube, Federico Paolo</creatorcontrib><creatorcontrib>Maßen, Felix</creatorcontrib><creatorcontrib>Polzer, Hans</creatorcontrib><creatorcontrib>Böcker, Wolfgang</creatorcontrib><creatorcontrib>Reidler, Paul</creatorcontrib><creatorcontrib>Saller, Maximilian Michael</creatorcontrib><creatorcontrib>Baumbach, Sebastian Felix</creatorcontrib><creatorcontrib>Hesse, Nina</creatorcontrib><title>Syndesmotic and Deltoid Injuries: Companions or Coincidences</title><title>Foot & ankle international</title><addtitle>Foot Ankle Int</addtitle><description>Background:
Syndesmotic complex injuries are supposedly associated with injuries to the deltoid ligament (DL) complex. Several syndesmosis classifications take DL injuries into account when rating the stability of the syndesmotic injury. Still, no study has yet assessed the frequency and severity of DL injuries in unstable syndesmotic injuries. The aim of this retrospective cohort study was to assess both the severity of the syndesmotic and DL injury in patients undergoing surgery for an unstable syndesmotic injury.
Methods:
The integrity of the syndesmotic and DL complex of 37 patients were assessed on MRI by 2 musculoskeletal radiologists. Eligible were adult patients with an acute, isolated, unstable syndesmotic injury (ligamentous or bony avulsions) who underwent surgery. The DL complex was classified as having 3 superficial (TNL/TSL/TCL) and 2 deep (aTTL/pTTL) components. Grade 0 indicated an intact ligament; grade I showed a periligamentous edema; grade II a partial tear presenting as laxity, irregular contour, or partial discontinuity with concomitant hyperintense signaling; grade III a complete tear; or grade IV in case of an avulsion fracture. Frequency and severity of DL injuries were assessed, and possible injury combinations analyzed using an h-cluster analysis and Mann-Whitney U test.
Results:
Mean severity (grade 0-3) was 2.6 ± 0.8 for the syndesmotic complex and 1.6 ± 1.1 for the DL (superficial 1.5 ± 1.1, deep 1.6 ± 1.1). Seven patients (19%) had no (n = 3; 8%) or minor (grade 1: n = 4; 11%) DL injuries. Overall, 2 different patient clusters and 4 separate ligament clusters were identified.
Conclusion:
Unstable syndesmotic injuries can occur isolated or with an accompanying DL injury. There appears to be a great heterogeneity between the severity of syndesmotic and deltoid ligament injuries.</description><subject>Adult</subject><subject>Ankle Injuries - diagnostic imaging</subject><subject>Ankle Injuries - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Joint Instability - surgery</subject><subject>Ligaments, Articular - diagnostic imaging</subject><subject>Ligaments, Articular - injuries</subject><subject>Ligaments, Articular - surgery</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>1071-1007</issn><issn>1944-7876</issn><issn>1944-7876</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMoVqs_wIvs0cvWTLK72YggUr8KBQ_qOaTZbE3ZTWqyK_Tfm9JaFMHTZJhn3gwPQmeARwCMXQJmABgzkgFhGQOyh46AZ1nKSlbsx3ecp2tggI5DWGAMjAI_RAPKKWCel0fo-mVlKx1a1xmVSFsld7rpnKmSiV303uhwlYxdu5TWOBsS52NnrDKVtkqHE3RQyybo020doreH-9fxUzp9fpyMb6epIqzs0kJLUKymNJ8xQsisUBQqyHKdY5bH24uirKuaQcFxTQmtOOU50Uqqgs2KOq_pEN1scpf9rNWV0rbzshFLb1rpV8JJI35PrHkXc_cpAHJaMs5jwsU2wbuPXodOtCYo3TTSatcHEXWUlBNS4ojCBlXeheB1vfsHsFhrF3-0x53znwfuNr49R2C0AYKca7FwvbdR2D-JX_AOieY</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Gaube, Federico Paolo</creator><creator>Maßen, Felix</creator><creator>Polzer, Hans</creator><creator>Böcker, Wolfgang</creator><creator>Reidler, Paul</creator><creator>Saller, Maximilian Michael</creator><creator>Baumbach, Sebastian Felix</creator><creator>Hesse, Nina</creator><general>SAGE Publications</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6713-4017</orcidid><orcidid>https://orcid.org/0000-0003-3995-3071</orcidid><orcidid>https://orcid.org/0000-0002-6287-6206</orcidid></search><sort><creationdate>20241101</creationdate><title>Syndesmotic and Deltoid Injuries: Companions or Coincidences</title><author>Gaube, Federico Paolo ; Maßen, Felix ; Polzer, Hans ; Böcker, Wolfgang ; Reidler, Paul ; Saller, Maximilian Michael ; Baumbach, Sebastian Felix ; Hesse, Nina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c278t-6ea1c7f335b7222b6c31d145e5075241668fdf71690f323d93952ecac67b6f5f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Ankle Injuries - diagnostic imaging</topic><topic>Ankle Injuries - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Joint Instability - surgery</topic><topic>Ligaments, Articular - diagnostic imaging</topic><topic>Ligaments, Articular - injuries</topic><topic>Ligaments, Articular - surgery</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gaube, Federico Paolo</creatorcontrib><creatorcontrib>Maßen, Felix</creatorcontrib><creatorcontrib>Polzer, Hans</creatorcontrib><creatorcontrib>Böcker, Wolfgang</creatorcontrib><creatorcontrib>Reidler, Paul</creatorcontrib><creatorcontrib>Saller, Maximilian Michael</creatorcontrib><creatorcontrib>Baumbach, Sebastian Felix</creatorcontrib><creatorcontrib>Hesse, Nina</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Foot & ankle international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gaube, Federico Paolo</au><au>Maßen, Felix</au><au>Polzer, Hans</au><au>Böcker, Wolfgang</au><au>Reidler, Paul</au><au>Saller, Maximilian Michael</au><au>Baumbach, Sebastian Felix</au><au>Hesse, Nina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Syndesmotic and Deltoid Injuries: Companions or Coincidences</atitle><jtitle>Foot & ankle international</jtitle><addtitle>Foot Ankle Int</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>45</volume><issue>11</issue><spage>1239</spage><epage>1246</epage><pages>1239-1246</pages><issn>1071-1007</issn><issn>1944-7876</issn><eissn>1944-7876</eissn><abstract>Background:
Syndesmotic complex injuries are supposedly associated with injuries to the deltoid ligament (DL) complex. Several syndesmosis classifications take DL injuries into account when rating the stability of the syndesmotic injury. Still, no study has yet assessed the frequency and severity of DL injuries in unstable syndesmotic injuries. The aim of this retrospective cohort study was to assess both the severity of the syndesmotic and DL injury in patients undergoing surgery for an unstable syndesmotic injury.
Methods:
The integrity of the syndesmotic and DL complex of 37 patients were assessed on MRI by 2 musculoskeletal radiologists. Eligible were adult patients with an acute, isolated, unstable syndesmotic injury (ligamentous or bony avulsions) who underwent surgery. The DL complex was classified as having 3 superficial (TNL/TSL/TCL) and 2 deep (aTTL/pTTL) components. Grade 0 indicated an intact ligament; grade I showed a periligamentous edema; grade II a partial tear presenting as laxity, irregular contour, or partial discontinuity with concomitant hyperintense signaling; grade III a complete tear; or grade IV in case of an avulsion fracture. Frequency and severity of DL injuries were assessed, and possible injury combinations analyzed using an h-cluster analysis and Mann-Whitney U test.
Results:
Mean severity (grade 0-3) was 2.6 ± 0.8 for the syndesmotic complex and 1.6 ± 1.1 for the DL (superficial 1.5 ± 1.1, deep 1.6 ± 1.1). Seven patients (19%) had no (n = 3; 8%) or minor (grade 1: n = 4; 11%) DL injuries. Overall, 2 different patient clusters and 4 separate ligament clusters were identified.
Conclusion:
Unstable syndesmotic injuries can occur isolated or with an accompanying DL injury. There appears to be a great heterogeneity between the severity of syndesmotic and deltoid ligament injuries.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>39310958</pmid><doi>10.1177/10711007241274712</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6713-4017</orcidid><orcidid>https://orcid.org/0000-0003-3995-3071</orcidid><orcidid>https://orcid.org/0000-0002-6287-6206</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1071-1007 |
| ispartof | Foot & ankle international, 2024-11, Vol.45 (11), p.1239-1246 |
| issn | 1071-1007 1944-7876 1944-7876 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11538799 |
| source | MEDLINE; SAGE Complete |
| subjects | Adult Ankle Injuries - diagnostic imaging Ankle Injuries - surgery Female Humans Joint Instability - surgery Ligaments, Articular - diagnostic imaging Ligaments, Articular - injuries Ligaments, Articular - surgery Magnetic Resonance Imaging Male Middle Aged Retrospective Studies Young Adult |
| title | Syndesmotic and Deltoid Injuries: Companions or Coincidences |
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