Association between the distal tibiofibular syndesmosis morphology classification and ankle osteoarthritis: a retrospective study

Abstract

Background: Syndesmosis injury is proposed to contribute to ankle stability and osteoarthritis (OA). However, whether distal tibiofibular syndesmosis structure is closely related to ankle OA is unclear. We hypothesized that different DTS morphology classifications would affect the biomechanics properties in ankle OA. The study aimed to determine the association between the distal tibiofibular syndesmosis (DTS) morphological classification and ankle OA.

Methods: This is a retrospective study examining imaging data of 147 patients (87 males and 60 females) with ankle OA. Magnetic resonance imaging was used to access the DTS morphological classification, according to measuring various parameters. Joint space narrowing and osteophytes were measured using ankle weight-bearing radiography. The classification and parameters were analyzed to determine the relationship between the syndesmosis classification and the abnormality of ankle OA.

Results: Five morphological classifications of the DTS, including Chevron (19.6%), Widow's peak (16.2%), Flat (22.3%), Trapezoid (32.0%), and Crescent (19.6%), were shown. There were statistical differences between DTS classification and tibial angle surface angle (TAS) (P = .009) and talar tilt angle (TTA) (P = .014). The TAS (degree) of the Crescent (86.47 ± 3.21) was less than Chevron (88.75 ± 2.72) (P = .006), Widow's peak (89.26 ± 3.15) (P = .001), Flat (88.83 ± 3.62) (P = .003) and Trapezoid (88.11 ± 2.62) (P = .041), respectively. The TTA (degree) of Crescent (86.83 ± 5.30) was less than Chevron (89.28 ± 2.46) and Widow's peak (89.82 ± 3.41). The men were greater than women for TAS (P = .008) and angle (P = .003), which are consistent with osteophyte (P = .019) and the modified Kellgren-Lawrence grades (P = .041) between gender.

Conclusions: DTS morphological classification might affect the biomechanics properties in TAS and TTA in ankle OA. In clinical practice, surgeons should pay attention to the effects of DTS on ankle OA.

Level of evidence: Level III, retrospective study.

Keywords: Ankle osteoarthritis; Distal tibiofibular syndesmosis; Morphology classification.

Fig. 1

The following parameters were measured at a 1 cm proximal level to the tibial platfond. a Distance between anterior tibial tubercle (Chaput) and most anterior tubercle of the fibula; b distance between posterior tibial tubercle (Volkmann) and most posterior tubercle of the fibula; c maximum vertical distance between the medial fibular cortex and the anterior and posterior tubercle tips of the tibia; d and the angle, between the anterior and posterior facets of the fibular notch of the tibia

Fig. 2

The angle is mainly measured by the ankle weight-bearing radiographs. a TAS: Tibial articular surface angle; b TTA: talar tilt angle; c TT: tibiotalar surface angle; d TLS: tibial lateral surface angle

Fig. 3

Five DTS morphological classifications. a Chevron; b Widow’s peak; c Flat; d Trapezoid; e Crescent

Fig. 4

The proportion of patients in the modified Kellgren–Lawrence grade and the Takakura–Tanaka classification, osteophytes, joint space narrowing. The total number for each column is 147. In Kellgren–Lawrence, A: Grade 1, B: Grade 2, C: Grade 3, D: Grade 4. In Takakura–Tanaka, A: I, B: II, C: IIIa, D: IIIb. In osteophytes and joint space narrowing, A: Normal, B: Mild, C: Moderate, D: Severe

Fig. 5

Differences between TAS and TTA in each classification. TAS: Tibial articular surface angle; TTA: Talar tilt angle (**P < 0.05)

Fig. 6

Baseline of participants based on DTS morphology classifications (**P < 0.05)