{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:20:24Z","timestamp":1777616424139,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,4,1]],"date-time":"2018-04-01T00:00:00Z","timestamp":1522540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>Background: Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, there exist no agreed on standard diagnostic criteria. Previous studies lack consistency with radiographic evaluation methods. The dynamic nature of the ankle joint supports analyzing anatomical parameters using weight-bearing films to assess for tibiofibular syndesmotic integrity. Methods: Weight-bearing tibiofibular syndesmosis radiographs of 39 male and 40 female patients were retrospectively analyzed by 3 investigators, at different levels of orthopaedic training. Measurements 1 cm above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space (TCS) were recorded and standardized by the fibular width (FW) at 2 time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators, and to ascertain underlying gender differences. Results: There was good intraobserver correlation (intraclass correlation coefficient [ICC] &gt; 0.90) among investigators for each parameter. A significant difference in the TFO was noted between genders (P &lt; .05). We establish the following radiographic (anteroposterior view) parameters for an intact syndesmosis: male patients, TCS &lt;4.57 mm or TCS\/FW &lt;29% and TFO &gt;9.29 mm or TFO\/FW &gt; 57%; female patients, TCS &lt;4.28 mm or TCS\/FW &lt;30% and TFO &gt;7.41 mm or TFO\/FW &gt;51%. Conclusions: Our study provides a more objective approach by utilizing weight-bearing radiographs and performing all measurements 1 cm above the tibial plafond.<\/jats:p>\n                  <jats:p>Levels of Evidence: Level IV<\/jats:p>","DOI":"10.1177\/1938640018766631","type":"journal-article","created":{"date-parts":[[2018,4,2]],"date-time":"2018-04-02T02:26:33Z","timestamp":1522635993000},"page":"211-217","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":23,"title":["Weight-Bearing Radiographic Analysis of the Tibiofibular Syndesmosis"],"prefix":"10.1177","volume":"12","author":[{"given":"Arsalan","family":"Amin","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP)"},{"name":"United States Navy, Washington, DC (CJ)"},{"name":"Skagit Regional Health, Mount Vernon, Washington (CS)"},{"name":"Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas (DCJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cory","family":"Janney","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP)"},{"name":"United States Navy, Washington, DC (CJ)"},{"name":"Skagit Regional Health, Mount Vernon, Washington (CS)"},{"name":"Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas (DCJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Sheu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP)"},{"name":"United States Navy, Washington, DC (CJ)"},{"name":"Skagit Regional Health, Mount Vernon, Washington (CS)"},{"name":"Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas (DCJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel C.","family":"Jupiter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP)"},{"name":"United States Navy, Washington, DC (CJ)"},{"name":"Skagit Regional Health, Mount Vernon, Washington (CS)"},{"name":"Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas (DCJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinod K.","family":"Panchbhavi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP)"},{"name":"United States Navy, Washington, DC (CJ)"},{"name":"Skagit Regional Health, Mount Vernon, Washington (CS)"},{"name":"Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas (DCJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,4,1]]},"reference":[{"key":"bibr1-1938640018766631","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2006.2195"},{"key":"bibr2-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldu020"},{"key":"bibr3-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(88)90072-1"},{"key":"bibr4-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110078400400605"},{"key":"bibr5-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000129152.81015.ad"},{"key":"bibr6-1938640018766631","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.0870"},{"key":"bibr7-1938640018766631","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1995.21.4.197"},{"key":"bibr8-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110079701801103"},{"key":"bibr9-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-011-1284-2"},{"key":"bibr10-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2271011865"},{"key":"bibr11-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110078901000308"},{"key":"bibr12-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110079301400805"},{"key":"bibr13-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-003-0147-5"},{"key":"bibr14-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110079501600304"},{"key":"bibr15-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000161090.86162.19"},{"key":"bibr16-1938640018766631","doi-asserted-by":"publisher","DOI":"10.1177\/107110079501600806"}],"container-title":["Foot &amp; 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