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Computed tomography scans were performed in neutral position, 15\u00b0 internal \/ external rotation, and 20\u00b0 dorsal \/ plantar flexion of the foot before and after cutting all syndesmotic ligaments. For each position, generated 3D models of the intact and injured distal tibiofibular joints were matched and analyzed by calculating three parameters: diastasis, anteroposterior displacement, and shortening of the fibula.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Transection of syndesmotic ligaments resulted in significant posterior translation of the fibula (4.34\u00b0, SD 1.63\u00b0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) compared to uninjured state for external rotation, significant anterior translation (-2.08\u00b0, SD 1.65\u00b0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) for internal rotation, and significant posterior translation (1.32\u00b0, SD 1.16\u00b0, <jats:italic>p<\/jats:italic>\u2009=\u20090.01) for dorsiflexion. Furthermore, the syndesmotic injury led to significantly increased clear space (0.46\u00a0mm, SD 0.46\u00a0mm, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) in external rotation of the foot.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>External rotation of the foot under loading seems to be the most responsive position for detection of isolated syndesmotic instability. Under external rotational stress, anteroposterior instability and increased clear space resulting from a complete isolated unstable syndesmotic lesion were most evident.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-024-05211-y","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T07:02:06Z","timestamp":1730530926000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The most responsive foot position for non-invasive detection of isolated unstable syndesmotic injuries \u2013 a 3D analysis"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1087-7503","authenticated-orcid":false,"given":"Firas","family":"Souleiman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5611-7476","authenticated-orcid":false,"given":"Martin","family":"Heilemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5051-0998","authenticated-orcid":false,"given":"Georg","family":"Osterhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6510-2943","authenticated-orcid":false,"given":"Pierre","family":"Hepp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-2480","authenticated-orcid":false,"given":"R. 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Additionally, ethical approval for this study was obtained from the internal review boards at Science Care (Phoenix, AZ, USA) and AO Research Institute Davos (Davos, Switzerland). This investigation was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki (1964) and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicaple.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"715"}}