Clinical examination or MRI for isolated syndesmotic injuries in acute ankle sprains?
A fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments is known as a syndesmosis. For example-distal tibiofibular joint is a syndesmotic joint between the tibia and fibula. Isolated syndesmosis injuries are more disabling than lateral ankle sprains although that occurs less frequently which ranges from 1-18% of all ankle sprains.
This study was intended towards evaluation of syndesmotic injuries in acute ankle sprains using MRI, role of clinical symptoms in the diagnosis of syndesmotic injuries and has put forward the importance of common clinical diagnostic tests.
Different clinical tests like squeeze test, external rotation test, drawer test, crossed-leg test (two examiners), local findings, ankle ligament palpation, cotton test were differentiated with MRI results (read by two blinded radiologists) as a reference standard. About 100 acute sprain injury patients without associated fractures in plane radiographs were considered.
Based on the inclusion criteria, 96 patients (about 57 %) were eligible where a ruptured anterior inferior tibiofibular ligament (AITFL) in 14 patients (15 %) by the MRI; 5 complete tears and 9 partial tears were manifested. Prediction of syndesmotic injuries was accurate (p = 0.039) by the evidence of pain at rest. Various other clinical tests revealed moderate to fair inter-rater reliabilities (κ = 0.37-0.52). With all the clinical tests, low sensitivity values were imparted (13.9-55.6 %).
The MRI scanning was superior to the clinical evaluation as it showed a syndesmotic lesion in 15 % of patients. In patients with ongoing pain at rest following ankle sprains, the MRI should be endorsed.