{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T03:56:45Z","timestamp":1794023805548,"version":"4.8.0"},"reference-count":56,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Ankle arthroscopy is widely used for diagnosis of syndesmotic instability, especially in subtle cases. To date, no published article has systematically reviewed the literature in aggregate to understand which instability values should be used intraoperatively. The primary aim was to systematically review the amount of tibiofibular displacement that correlates with syndesmotic instability after a high ankle sprain. A secondary aim is to assess the quality of such research.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic searches of EMBASE (Ovid) and MEDLINE via PubMed, CINAHL, Web of Science, and Google Scholar were used. Inclusion criteria: studies that arthroscopically evaluated the fibular displacement at various stages of syndesmotic ligament injury. Two reviewers independently extracted data and assessed methodological quality using the Anatomical Quality Assessment (AQUA) Tool and methodological index for non\u2010randomized studies (MINORS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight cadaveric studies and three clinical studies were included for review. All studies reported displacement in the coronal plane, four studies reported in the sagittal plane, and one reported findings in the rotational plane. Four cadaveric studies had a similar experimental set up and the weighted mean associated with instability in the coronal plane could be calculated and was 2.9\u00a0mm at the anterior portion of the distal tibiofibular joint and 3.4\u00a0mm at the posterior portion. Syndesmotic instability in the sagittal plane is less extensively studied, however available data from a cadaveric study suggests thresholds of 2.2\u00a0mm of posterior fibular translation when performing an anterior to posterior hook test and 2.6\u00a0mm of anterior fibular translation when performing a posterior to anterior hook test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results have concluded that the commonly used 2.0\u00a0mm threshold value of distal tibiofibular diastasis may lead to overtreatment of syndesmotic instability, and that using threshold values of 2.9\u00a0mm measured at the anterior portion of the incisura and 3.4\u00a0mm at the posterior portion may represent better cut off values. Given the ready availability of 3\u00a0mm probes among standard arthroscopic instrumentation, at the very least surgeons should use 3\u00a0mm in lieu of 2\u00a0mm probes intraoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06067-5","type":"journal-article","created":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T17:02:30Z","timestamp":1590426150000},"page":"310-323","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Arthroscopic coronal plane syndesmotic instability has been over\u2010diagnosed"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8116-9948","authenticated-orcid":false,"given":"Noortje C.","family":"Hagemeijer","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences Amsterdam Zuidoost The Netherlands"},{"name":"<!--<label>3<\/label>--> Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"<!--<label>4<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC\/VUMC IOC Research Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdelaziz","family":"Elghazy","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>5<\/label>--> Mansoura Faculty of Medicine Mansoura University Hospital Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Waryasz","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>6<\/label>--> Foot and Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Guss","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>6<\/label>--> Foot and Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital Boston USA"},{"name":"<!--<label>7<\/label>--> Massachusetts General Hospital, Newton\u2010Wellesley Hospital, Harvard Medical School Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W.","family":"DiGiovanni","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>6<\/label>--> Foot and Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital Boston USA"},{"name":"<!--<label>7<\/label>--> Massachusetts General Hospital, Newton\u2010Wellesley Hospital, Harvard Medical School Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino M. 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October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. DiGiovanni reports non-financial support from FAI, FAO, Eur J FAS outside the submitted work. Dr. Guss reports other support from Extremity Medical, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}