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- Unlocking the surgical threshold: WBCT as…
Unlocking the surgical threshold: WBCT as a predictor in unstable ankle syndesmosis injuries
Key Points
- Weight-bearing computed tomography (WBCT) enables functional assessment of the syndesmosis under load and allows direct side-to-side comparison.
BACKGROUND & OBJECTIVE
Accurate diagnosis of ankle syndesmosis instability remains a persistent challenge in clinical practice. These injuries are more common than previously assumed, with approximately 20% of ankle sprains involving the distal syndesmosis (1). Higher-grade injuries can increase tibiotalar contact pressures, accelerating articular degeneration.
Therefore, early identification of instability is critical to guide management decisions (conservative or surgical) and reduce the risk of long-term joint dysfunction. Clinical assessment represents an important initial step. While several clinical tests demonstrate reasonable diagnostic accuracy for detecting syndesmotic injury (e.g. squeeze test, external rotation test), these are largely pain-provocation tests and are therefore limited in their ability to determine true mechanical instability or diastasis (1).
Weight-bearing computed tomography (WBCT) has emerged as a promising non-invasive alternative, enabling assessment of the distal syndesmosis under physiological load and direct comparison with the contralateral limb. Despite increasing clinical use, there is no clear consensus regarding diagnostic thresholds for instability. This study aimed to evaluate the utility of comparative WBCT and establish a clinically relevant cut-off value for identifying unstable syndesmotic injury.
Weight-bearing computed tomography may be particularly valuable as a rule-out tool, helping clinicians identify stable injuries and potentially avoid unnecessary invasive procedures such as arthroscopy.
METHODS
- This retrospective case–control study included patients aged 14–60 years (with closed physes) presenting with suspected acute syndesmotic injury who underwent WBCT between 2019 and 2022.