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The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P\u2010US with progressive stages of syndesmotic ligamentous transection under external rotation stress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P\u2010US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior\u2013inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior\u2013inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0\u00a0Nm) state and with 4.5, 6.0, 7.5, and 9.0\u00a0Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P\u2010US and fluoroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When assessed with P\u2010US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5\u00a0Nm of external rotation torque when compared to intact state with a TFCS\u2010opening of 2.6\u2009\u00b1\u20092\u00a0mm, <jats:italic>p<\/jats:italic>\u2009=\u20090.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P\u2010US and fluoroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>P\u2010US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS\u2010opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5\u00a0Nm torque was sufficient to detect a difference of 2.6\u00a0mm after the IOL cut.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07058-4","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T05:05:01Z","timestamp":1658811901000},"page":"1986-1993","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability: a cadaveric study"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8116-9948","authenticated-orcid":false,"given":"N. C.","family":"Hagemeijer","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery and Sports Medicine Amsterdam UMC location University of Amsterdam Meibergdreef 9, Zuidoost 1105 AZ Amsterdam The Netherlands"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"},{"name":"<!--<label>8<\/label>--> Department of Orthopaedic Surgery Massachusetts General Hospital 55 Fruit Street 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Lubberts","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Saengsin","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery, Faculty of Medicine Chiang Mai University 110 Inthawarorot, Sri Phum subdistrict, Mueang Chiang Mai District, Chiang Mai 50200 Chiang Mai Thailand"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Bhimani","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Sato","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. R.","family":"Waryasz","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>4<\/label>--> Foot and Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital Yawkey Building, 55 Fruit St 02114 Boston MA USA"},{"name":"<!--<label>7<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS) IOC Research Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M. M. 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