{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:56:33Z","timestamp":1793105793620,"version":"4.5.0"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T00:00:00Z","timestamp":1691798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T00:00:00Z","timestamp":1691798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T00:00:00Z","timestamp":1691798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["1120220N"],"award-info":[{"award-number":["1120220N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["1842619N"],"award-info":[{"award-number":["1842619N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["V426622N"],"award-info":[{"award-number":["V426622N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["1120220N"],"award-info":[{"award-number":["1120220N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["1842619N"],"award-info":[{"award-number":["1842619N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["V426622N"],"award-info":[{"award-number":["V426622N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,11]]},"abstract":"Abstract<\/jats:title>Purpose<\/jats:title>Acute syndesmotic ankle injuries continue to impose a diagnostic dilemma and it remains unclear whether weightbearing and\/or external rotation should be added during the imaging process. Therefore, the aim of this study was to assess if combined weightbearing and external rotation increases the diagnostic sensitivity of syndesmotic ankle instability using weightbearing CT (WBCT) imaging, compared to isolated weightbearing.<\/jats:p><\/jats:sec>Methods<\/jats:title>In this retrospective study, patients with an acute syndesmotic ankle injury were analysed using a WBCT (N<\/jats:italic>\u2009=\u200921; Age\u2009=\u200931.6\u2009\u00b1\u200914.1 years old). Inclusion criteria were an MRI confirmed syndesmotic ligament injury imaged by a WBCT of the ankle during weightbearing and combined weightbearing\u2010external rotation. Exclusion criteria consisted of fracture associated syndesmotic injuries. Three\u2010dimensional (3D) models were generated from the CT slices. Tibiofibular displacement and talar rotation were quantified using automated 3D measurements (anterior tibiofibular distance (ATFD), Alpha angle, posterior Tibiofibular distance (PTFD) and Talar rotation (TR) angle in comparison to the contralateral non\u2010injured ankle.<\/jats:p><\/jats:sec>Results<\/jats:title>The difference in neutral\u2010stressed Alpha angle and ATFD showed a significant difference between patients with a syndesmotic ankle lesion and contralateral control (P<\/jats:italic>\u2009=\u20090.046 and P<\/jats:italic>\u2009=\u20090.039, respectively). The difference in neutral\u2010stressed PTFD and TR angle did not show a significant difference between patients with a syndesmotic ankle lesion and healthy ankles (n.s.).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Application of combined weightbearing\u2010external rotation reveals an increased ATFD in patients with syndesmotic ligament injuries. This study provides the first insights based on 3D measurements to support the potential relevance of applying external rotation during WBCT imaging. In clinical practice, this could enhance the current diagnostic accuracy of subtle syndesmotic instability in a non\u2010invasive manner. However, to what extent certain displacement patterns require operative treatment strategies has yet to be determined in future studies.<\/jats:p><\/jats:sec>Level of evidence<\/jats:title>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07536-3","type":"journal-article","created":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T10:02:01Z","timestamp":1691834521000},"page":"4886-4894","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Application of external torque enhances the detection of subtle syndesmotic ankle instability in a weight\u2010bearing CT"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2333-5386","authenticated-orcid":false,"given":"M.","family":"Peiffer","sequence":"first","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"},{"name":" Department of Human Structure and Repair Ghent University Corneel Heymanslaan 10 9000 Ghent OVL Belgium"},{"name":" Foot and Ankle Research and Innovation Laboratory (FARIL) Harvard Medical School\u2010Massachusetts General Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Dhont","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Cuigniez","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Tampere","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Ashkani\u2010Esfahani","sequence":"additional","affiliation":[{"name":" Foot and Ankle Research and Innovation Laboratory (FARIL) Harvard Medical School\u2010Massachusetts General Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"D\u2019Hooghe","sequence":"additional","affiliation":[{"name":" Aspetar Orthopaedic and Sports Medicine Hospital Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Audenaert","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"},{"name":" Department of Human Structure and Repair Ghent University Corneel Heymanslaan 10 9000 Ghent OVL Belgium"},{"name":" Department of Electromechanics Op3Mech Research Group, University of Antwerp 2020 Antwerp Belgium"},{"name":" Department of Trauma and Orthopedics Addenbrooke\u2019s Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Burssens","sequence":"additional","affiliation":[{"name":" Department of Orthopaedics and Traumatology Ghent University Hospital 9000 Ghent OVL Belgium"},{"name":" Department of Human Structure and Repair Ghent University Corneel Heymanslaan 10 9000 Ghent OVL Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,12]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.25049"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100717740330"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12880\u2010022\u201000913\u20103"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000129152.81015.ad"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720917682"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720936596"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11548\u2010018\u20101727\u20105"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.10.003"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010022\u201004229\u20109"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716666277"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.1110"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079801901002"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010015\u20103604\u2010x"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201007058\u20104"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070102200103"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS\u2010D\u201013\u201000135"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010020\u201003649\u20109"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40634\u2010020\u20100220\u20106"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2019.10.010"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010017\u20102823\u20102"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007211034522"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010023\u201002256\u20102"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.00470"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716634757"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.3.170066"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.101B3.BJJ\u20102018\u20100829.R1"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.25318"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2022.106701"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107366"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2019.05.019"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231153144"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514529643"},{"key":"e_1_2_10_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010018\u20103074\u20106"},{"key":"e_1_2_10_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006008\u20102"},{"key":"e_1_2_10_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010015\u20103942\u20108"},{"key":"e_1_2_10_37_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01537"},{"key":"e_1_2_10_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.12.001"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-023-07536-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-023-07536-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-023-07536-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-023-07536-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T09:51:43Z","timestamp":1760867503000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-023-07536-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,12]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1007\/s00167-023-07536-3"],"URL":"https:\/\/doi.org\/10.1007\/s00167-023-07536-3","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,12]]},"assertion":[{"value":"9 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Matthias Peiffer, MD, has nothing to disclose; Thibaut Dhont, BSc, has nothing to disclose; Francis Cuigniez, MD, has nothing to disclose; Thomas Tampere, MD, has nothing to disclose; S. Ashkani-Esfahani, MD,\u00a0has nothing to disclose; Pieter D\u2019Hooghe, MD, PhD, has nothing to disclose; Emmanuel Audenaert, MD, PhD, has nothing to disclose; Arne Burssens, MD, PhD, has nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"IRB:EC 2019\/0887 (Institutional Review Board of University Hospital Ghent).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"None","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}