Summary: The bisector of angle formed by two lines tangent to anterior and posterior fibula & tibia cortices was found strongly reliable providing patient- and level-specific direction for syndesmotic fixation.

Anatomic syndesmosis reduction is necessary to restore ankle biomechanics and prevent poor clinical outcomes, but malreduction can be encountered frequently since the ideal fixation angle varies between patients and fixation levels. Recent studies have shown that any malalignment in syndesmotic fixation can lead to iatrogenic malreduction, and if the fixation is not placed perpendicular to the tibiofibular joint, the fibula may remain displaced. Ideal syndesmotic alignment is proposed to be the line connecting the centroids of fibula and tibia. We hypothesized that angle bisector of two lines tangent to anterior and posterior tibia & fibula provides accurate, patient-specific and level-specific angle for syndesmotic fixation. Lower extremity CT angiography of 50 consecutive patients (25 male, 25 female) without evident ankle pathology were evaluated. The average age was 52.8 (±18, range:18-75). Lines tangent to anterior and posterior cortices of tibia and fibula were drawn in the axial plane at both 2 cm and 3.5 cm distance to tibial plafond. Bisector of the angle formed between these lines was drawn and its relationship with the centroidal axis which is proposed to be the ideal syndesmotic axis was evaluated. The angle between bisector line & centroidal axis and the distance between their most lateral intersections with fibula were calculated. The measurements were made by three blinded observers. Interobserver and intraobserver consistencies were evaluated by ICC, in 2-way & mixed-effect model analyzing absolute agreement of exact measures. Independent samples, 2-tailed t-test was used to compare the values at 2 cm and 3.5 cm levels. The average centroidal axis-bisector angle was 2.1±2.1° at 2 cm and 0.6±1.3° at 3.5 cm level. The average distance to actual syndesmosis entry point was 1.0±0.9 mm at 2 cm and 0.4±0.4 mm at 3.5 cm level. The values didn’t show any significant difference according to gender. Intra- and inter-observer reliability analyses showed excellent correlation in all parameters (ICC>0.90). Angle bisector method was found reliable for determining accurate syndesmotic alignment and lateral entry point with a narrow range of variability between patients and also high consistency between observers. Angle bisector method can also be used intraoperatively with help of two K-wires and a sterile goniometer. Two K-wires tangent to anterior and posterior surfaces of tibia and fibula can be placed and the angle between these K-wires can be calculated with the help of a sterile goniometer. Then, the drill and preferred fixation implant can be applied in direction of the angle bisector. It can provide a patient- and level-specific angle for the application of syndesmotic implants without increasing the fluoroscopy exposure. It has the potential to be reproduced in a clinical setting thus can standardize the treatment of syndesmotic injuries compared to non-standardized conventional methods. Angle bisector method can pave the way for designing a new jig allowing accurate syndesmotic fixation. Its use can have a broad impact on functional outcomes of ankle injuries by decreasing the malreduction rates. However, cadaveric validation and safety studies should be conducted before possible clinical usage.

Good Short Term Outcomes With Percutaneous Fixation of Comminuted Displaced Intra-Articular Calcaneal Fractures ePoster Presentation Jessica Thor, MBBS, SINGAPORE Darshana Chandrakumara, SINGAPORE Raj Kumar Socklingam, , SINGAPORE Charles Kon Kam King, MBBS, FRCS, SINGAPORE
A Prospective Study to Evaluate The Results Of Endoscopic Management For Haglund’s Syndrome Using 3 Portal Technique ePoster Presentation Vinod Kumar, MBBS, MS, DNB, MNAMS, INDIA Ananya Sharma, MBBS, MS, DNB , INDIA Keshave Singh, MBBS, MS (Ortho), INDIA
Total Ankle Arthroplasty With and Without Tibial Stem: Exploring Differences in Post-Operative Migration and Beta Angles ePoster Presentation S. Ali Ghasemi, MD, UNITED STATES Jetha Sreedhar Tallapaneni, MBA, UNITED STATES Zachary Vaupel, UNITED STATES Paul Fortin
Sex Differences in Biomechanical Properties of the Achilles Tendon May Predispose Men to Higher Risk of Injury ePoster Presentation Arianna L Gianakos, DO, UNITED STATES Hayden Hartman, BS, UNITED STATES Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS John G. Kennedy, MD, FRCS, UNITED STATES James D. Calder, OBE, MBBS, MD, PhD, FRCS, FFSEM(UK), UNITED KINGDOM
U.S. Rugby-7s Men's and Women's Ankle Injury Incidence and Mechanism: A 7-Year Comparison ePoster Presentation Kiera Guyor Borthwick, BS, MD (2026), UNITED STATES Victor Lopez Jr., DO, UNITED STATES Richard Ma, MD, UNITED STATES Christian Victoria, MPH, UNITED STATES Xinning Li, MD, UNITED STATES Joseph Kocan, MD, UNITED STATES Giulia DiSanto, MSAT, MD (2025), UNITED STATES Som Singh, MD (2023), UNITED STATES Answorth A. Allen, MD, UNITED STATES
Clinical outcomes of foot and ankle fractures treated with a new type ff u-HA/PLLA bone screw ePoster Presentation Shinji Imade, MD, PhD, JAPAN Masaya Sato, MD, JAPAN Takuya Manako, MD, JAPAN Takuya Wakatsuki, MD, JAPAN Yuji Uchio, MD, PhD, JAPAN
Return to Sport and Daily Activities After Modification of the Broström Procedure in Patients with Chronic Lateral Ankle Instability: Utilizing One Internal Brace for Augmentation of Both the ATFL and CFL ePoster Presentation Benjamin Murray, DO, UNITED STATES Jetha Sreedhar Tallapaneni, MBA, UNITED STATES S. Ali Ghasemi, MD, UNITED STATES Paul Fortin
Does Scaffold Augmentation Improve Microfractures Patient-Reported Outcomes?: A Systematic Review ePoster Presentation Guttu T. Maskalo, MS, UNITED STATES Theodorakys Marín Fermín, MD, VENEZUELA Elizabeth Octavia Clayton, MS, UNITED STATES Christopher D Murawski, MD, UNITED STATES MaCalus V. Hogan, MD, MBA, UNITED STATES Emmanouil Papakostas, MD, FEBSM, QATAR Pieter D'Hooghe, MD PhD MBA, QATAR John G. Kennedy, MD, FRCS, UNITED STATES
A Systematic Review of Extracorporeal Shock Wave Therapy For Insertional and Non-Insertional Achilles Tendinopathy ePoster Presentation Mohammad T Azam, BS, UNITED STATES Matthew B Weiss, BS, UNITED STATES James J Butler, MB BCh, UNITED STATES Mehreen Pasha, BS, UNITED STATES Nathan Jia, MD, UNITED STATES John G. Kennedy, MD, FRCS, UNITED STATES
Outcome of Modified Mini-Open Brostrom Gould Ankle Surgery on Chronic Ankle Instability ePoster Presentation Amarinda Tan, SINGAPORE Mark Chan, , SINGAPORE Charles Kon Kam King, MBBS, FRCS, SINGAPORE Wei Sheng Foong, , SINGAPORE Darshana Chandrakumara, SINGAPORE Raj Kumar Socklingam, , SINGAPORE
Determining the Minimum Clinically Important Difference of Outcomes Following Lower Extremity Orthopedic Procedures ePoster Presentation Michael A. Hewitt, BA, UNITED STATES Carson Keeter, MS, UNITED STATES Sara Buckley, DO, UNITED STATES Shayne York, MS, UNITED STATES Kenneth J. Hunt, MD, UNITED STATES
Prevention Of Ankle Sprains In Sport: A Systematic Literature Review ePoster Presentation Yonatan Kaplan, PhD, MSc(Med), BSc(Physio), ISRAEL
Posterior Ankle Impingement: It Is Not All About the Os Trigonum ePoster Presentation Nacime Salomao Barbachan Mansur, MD, PhD, UNITED STATES Aly Fayed, MD, M.SC., UNITED STATES Karthikeyan Chinnakkannu, MD, UNITED STATES Natalie Glass, PhD, UNITED STATES Phinit Phisitkul, MD, UNITED STATES Annunziato Amendola, MD, UNITED STATES John E Femino, MD, UNITED STATES
The Axial Rotation Between The Femoral Neck And Ankle Joint Influences The Kinematics In Normal Knees ePoster Presentation Kenichi Kono, MD, PhD, JAPAN Shuji Taketomi, MD, PhD, JAPAN Takaharu Yamazaki, PhD, JAPAN Ryota Yamagami, MD, JAPAN Kohei Kawaguchi, MD, PhD, JAPAN Ryo Murakami, MD, JAPAN Tomofumi Kage, JAPAN Takahiro Arakawa, MD, JAPAN Masashi Tamaki, MD, PhD, JAPAN Hiroshi Inui, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN Tetsuya TOMITA, MD, PhD, JAPAN
Arthroscopic Technique Yields Better Outcomes Than Open Technique For Subtalar Arthrodesis-A Systematic Review ePoster Presentation Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Terence Dsouza, MS, DNB, FNB, INDIA Ramakanth Rajagopalakrishnan, D.ortho, DNB(ortho).D.SICOT, INDIA Meet Mehta, MD orthopaedics, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
All-Inside Endoscopic Anatomic Reconstruction Leads To Satisfactory Functional Outcomes In Patients With Chronic Ankle Instability ePoster Presentation Christel Charpail, MD, FRANCE Stéphane Guillo, MD, FRANCE Haruki Odagiri, MD, JAPAN Thomas Bauer, MD, PhD, FRANCE Alexandre Hardy, MD, FRANCE
Viability And Outcomes Of Osteochondral Lesions Of The Talar Dome Using A One-Single Stage Autologous Matrix Combining PRGF + Chondral Chips. Our Technique And Experience. ePoster Presentation David Barastegui, MD, PhD, MSc, SPAIN Alfred Ferre, BPT, SPAIN Patricia Laiz-Boada, BS, SPAIN Roberto Seijas-Vazquez, MD, PhD, Prof., SPAIN Daniel Izquierdo, BSN, SPAIN Silvia Vizcaino, BSN, SPAIN Xavier Cuscó, MD, SPAIN Montserrat Garcia Balletbo, MD, PhD, SPAIN Ramon Cugat Bertomeu, MD, PhD, SPAIN
Risk Factor Of Fifth Metatarsal Stress Fractures In 81 Soccer Players : Retrospective Cohort Study ePoster Presentation Hiroki Ukita, MD, JAPAN Yusei Funakoshi, MD, PhD, JAPAN Yuto Nakamura, MD, JAPAN
Accuracy of Radiographic Techniques to Identify the True Calcaneofibular Ligament Insertion for Lateral Ankle Ligament Reconstruction ePoster Presentation Benjamin Murray, DO, UNITED STATES S. Ali Ghasemi, MD, UNITED STATES Matthew Lipphardt, MD, UNITED STATES Clark Yin, MD, UNITED STATES Paul Fortin
Outcomes Following Broström Repair with InternalBrace Ligament Augmentation vs. Broström Repair Alone for the Treatment of Anterior Talofibular Ligament Injury of the Lateral Ankle ePoster Presentation Spencer M Comfort, BS, UNITED STATES Grant J Dornan, MS, UNITED STATES Daniel C. Marchetti, MS, UNITED STATES C Thomas Haytmanek, MD, UNITED STATES Thomas O. Clanton, MD, UNITED STATES
Ankle Pain Is Aggravated Following Medial Opening-Wedge High Tibial Osteotomy In Patients With Concurrent Ankle Osteoarthritis ePoster Presentation Keun Young Choi, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Yong In, MD, PhD, KOREA, REPUBLIC OF
Prognostic Factors Affecting Osteochondral Allograft Transplantation for Treatment of Osteochondral Lesions of the Talus ePoster Presentation Jonathan Andrew Ledesma, MD, UNITED STATES S. Ali Ghasemi, MD, UNITED STATES
Ankle Distraction Arthroplasty: A Survivorship Review and Meta-Analysis ePoster Presentation Anthony Santo Machi, MD, UNITED STATES S. Ali Ghasemi, MD, UNITED STATES Joshua Rory Buksbaum, BS, UNITED STATES S Rozbruch, UNITED STATES Austin T. Fragomen, MD, UNITED STATES
Return to Play Following Lateral Ankle Ligament Repair: A Systematic Review ePoster Presentation Matthew Civilette, MD, UNITED STATES Trevor Wyand, BS, UNITED STATES Heath Patrick Gould, MD, UNITED STATES Gregory P Guyton, MD, UNITED STATES
Preoperative Resilience Among Patients Undergoing Sports, Trauma, and Reconstructive Surgery ePoster Presentation Michael A. Hewitt, BA, UNITED STATES Sara Buckley, DO, UNITED STATES Kenneth J. Hunt, MD, UNITED STATES
Open versus Percutaneous Techniques and Time to Surgery for Achilles Rupture Repairs ePoster Presentation Kenneth J. Hunt, MD, UNITED STATES Jeremy Kalma, UNITED STATES Michael A. Hewitt, BA, UNITED STATES Sara Buckley, DO, UNITED STATES Katherine Drexelius, BS, UNITED STATES Daniel K Moon, MD, MS, MBA, UNITED STATES Joshua Metzl, MD, UNITED STATES Courtney Grimsrud, MD, UNITED STATES
A Review of Medial Subtalar Dislocation Caused by Low Energy Trauma ePoster Presentation Sushant Kishor, MBBS, D.ORTHO, INDIA
The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions ePoster Presentation Julian Hollander, BSc, NETHERLANDS Jari Dahmen, MD, BSc, NETHERLANDS Kaj Emanuel, MD, PhD, NETHERLANDS Sjoerd A.S. Stufkens, MD, PhD, NETHERLANDS John G. Kennedy, MD, FRCS, UNITED STATES Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS
Efficacy of PRP and Steroid Injection in Treatment of Chronic Plantar Fascitis - A Prospective Double Blind Study ePoster Presentation Prasad Soraganvi, MBBS, MS, DNB, MRCS, SICOT-dip, INDIA
Barefoot Running: What The Sports Physician Needs To Know ePoster Presentation Yonatan Kaplan, PhD, MSc(Med), BSc(Physio), ISRAEL
Autologous Bone Grafting With Periosteum Transfer For Treatment Of Large Talar Osteochondral Defects ePoster Presentation Dimitrios Nikolopoulos, PhD, GREECE George Safos, MD, GREECE Petros Safos, MD, GREECE Konstantinos Moustakas, MD, GREECE Neoptolemos Sergides, MD, GREECE ΜΠΟΝΑΤΣΟΣ ΣΠΥΡΙΔΩΝ, GREECE
Acute Achilles Tendon Rupture. Evaluation Of Practices and Outcomes Following a Large Multicenter Retrospective And Prospective Study ePoster Presentation Christel Charpail, MD, FRANCE Eric Laboute, MD, FRANCE Marc Saab, MD, FRANCE Julien Beldame, MD, FRANCE Sixtine Regnard, MD, FRANCE Jean-Charles Giunta, MD, FRANCE Raphaël Coursier, MD, PhD, FRANCE Alexandre Caubère, MD, FRANCE Ali Ghorbani, FRANCE
Favorable Outcomes Following Extracorporeal Shockwave Therapy for Chronic Non-Insertional Achilles Tendinopathy compared to Insertional Achilles Tendinopathy: A Retrospective Review ePoster Presentation James J Butler, MB BCh, UNITED STATES Mohammad T Azam, BS, UNITED STATES Brittany DeClouette, MD, UNITED STATES Cian Walls, UNITED STATES George Jejelava, BS, UNITED STATES Danny Zheng, MD, UNITED STATES John G. Kennedy, MD, FRCS, UNITED STATES
Risks Associated with Posterior Ankle Hindfoot Arthroscopy Complications ePoster Presentation Aly Fayed, MD, M.SC., UNITED STATES Nacime Salomao Barbachan Mansur, MD, PhD, UNITED STATES Karthikeyan Chinnakkannu, MD, UNITED STATES Natalie Glass, PhD, UNITED STATES Phinit Phisitkul, MD, UNITED STATES Annunziato Amendola, MD, UNITED STATES John E Femino, MD, UNITED STATES
Achilles Tendon Tissue Turnover Prior to and Immediately After Acute Rupture in Humans ePoster Presentation Allan Cramer, MD, PhD, DENMARK Grith Højfeldt, PhD, DENMARK Jakob Agergaard, PhD, DENMARK Gerrit van Hall, Prof., DENMARK Jesper Olsen, PhD, DENMARK Per Hölmich, DMSc, Prof., DENMARK Michael Kjaer, Prof., MD, DENMARK Kristoffer W. Barfod, MD, PhD, Prof., DENMARK
Arthroscopic treatment of the early stages of the First Metatarsophalangeal Joint Results in Good Clinical Outcomes and Pain Relief in Two Years of Follow-Up ePoster Presentation Urszula E. Zdanowicz, MD, POLAND Marta Gabriela Kubisa, MD, POLAND
Donor Site Morbidity of Distal Stump Suturing of Peroneus Longus to Peroneus Brevis Compared to Without Suturing for ACL Reconstruction – A Randomized Controlled Trials ePoster Presentation Andri M. Lubis, Prof, MD, PhD, INDONESIA Ihsan Oesman, MD, INDONESIA Ivan Mucharry Dalitan, MD, INDONESIA Witantra Dhamar Hutami, MD, INDONESIA
Relationship Between Lateral Ankle Laxity and Generalized Joint Laxity in Subjects with Healthy Ankles ePoster Presentation Takuji Yokoe, MD, PhD, JAPAN Etsuo Chosa, MD, PhD, Prof., JAPAN Takuya Tajima, MD, PhD, JAPAN Nami Yamaguchi, MD, JAPAN Yudai Morita, MD, JAPAN
Incidence of Acute Achilles Repair Surgeries in the Peri-Pandemic COVID Era: And Parallels to the Current 2021-22 NFL Season ePoster Presentation Andrew S Bi, MD, UNITED STATES Mohammad T Azam, BS, UNITED STATES James J Butler, MB BCh, UNITED STATES Michael J Alaia, MD, UNITED STATES Laith M. Jazrawi, MD, UNITED STATES Guillem Gonzalez-Lomas, MD, UNITED STATES John G. Kennedy, MD, FRCS, UNITED STATES
Screw Fixation for Athlete’s Fifth Metatarsal Stress Fracture (Jones fracture) ePoster Presentation Yuto Nakamura, MD, JAPAN Yusei Funakoshi, MD, PhD, JAPAN Hiroki Ukita, MD, JAPAN
Prospective Study of Jones Fractures Screening ePoster Presentation Hiroaki Seto, MD, PhD, JAPAN
Can Full Thickness Peroneus Longus Graft Be Used For ACL Reconstruction ? – A 3 Year Prospective Study With Isokinetic Testing of and Functional Outcomes of Ankle ePoster Presentation Arumugam Sivaraman, MS(Orth), AB(IM)(USA), FRCS(Glasg), INDIA Prakash Ayyadurai, MS, INDIA Suresh Perumal, MS(Orth), INDIA Parthiban Jeganathan, MS, INDIA Avinash Mahender, MBBS, D.ortho, DNB ortho, INDIA Vikram Rao, MD , INDIA Thiagarajan Alwar, MD, INDIA
Endoscopic Flexor Hallucis Longus Tendon Transfer As a Treatment Modality In Acute Achilles Tendon Rupture. A Case Series With A Minimum of 6 Months of Follow-Up ePoster Presentation Michail Kotsapas, MD, MSc, GREECE Apostolos Polyzos, MD, GREECE Ioannis Vasiadis, MD, GREECE Alexandros Eleftheropoulos, MD, GREECE
Treatment of Acute Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-Analyses ePoster Presentation Dexter Seow, MBBCh, BAO, UNITED STATES Wasif Islam, BS, UNITED STATES Mohammad T Azam, BS, UNITED STATES Matthew L Duenes, MD, UNITED STATES James J Butler, MB BCh, UNITED STATES James Hui, MBBS, FRCS, FAMS, M.D. (Orthopaedic Surgery), SINGAPORE Christopher Jon Pearce, MBChB MRCS FRCS (Tr&Orth), SINGAPORE John G. Kennedy, MD, FRCS, UNITED STATES
Clinical and Biomechanical Results of Suture Button Fixation for Treatment of Ligamentous Lisfranc Injury: A Systematic Review and Meta-Analysis ePoster Presentation Caroline Park Hudson, MD, UNITED STATES Billy Insup Kim, MD, UNITED STATES Deepak Varun Chona, MD, UNITED STATES Brian Chei-Fai Lau, MD, UNITED STATES
Minutes Per Game and Usage Rate Associated with Time Loss after Ankle Injury: A Characterization of Foot and Ankle Injuries and Associated Risk Factors in National Basketball Association Athletes ePoster Presentation Sailesh Vardhan Tummala, MD, UNITED STATES
4% Annual Revision Rate in Ankle Distraction for Ankle Osteoarthritis: A Systematic Review and Meta-Analysis ePoster Presentation Julian Hollander, BSc, NETHERLANDS Jari Dahmen, MD, BSc, NETHERLANDS Liam Paget, MD, NETHERLANDS Tobias Stornebrink, MD, NETHERLANDS Quinten G.H. Rikken, MD, NETHERLANDS Inger Sierevelt, NETHERLANDS Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Sjoerd A.S. Stufkens, MD, PhD, NETHERLANDS
Transplantation Of Parathyroid Hormone–Treated Achilles Tendon Promotes Meniscal Regeneration in a Rat Meniscal Defect Model ePoster Presentation Kazuya Nishino, MD, JAPAN Yusuke Hashimoto, MD, PhD, JAPAN Yohei Nishida, MD, JAPAN Kumi Orita, PhD, JAPAN Junsei Takigami, MD, PhD, JAPAN Hiroaki Nakamura, MD, PhD, JAPAN

Menu

Search Filters

Cortices of Fibula and Tibia Can Provide Landmarks for Accurate Syndesmotic Fixation Angle: Computed Tomography Validation of Angle Bisector Method

Cortices of Fibula and Tibia Can Provide Landmarks for Accurate Syndesmotic Fixation Angle: Computed Tomography Validation of Angle Bisector Method

More 2023 Congress Foot & Ankle ePosters

More 2023 ISAKOS Congress Content

Menu

Search Filters

Sign-in to ISAKOS

Cortices of Fibula and Tibia Can Provide Landmarks for Accurate Syndesmotic Fixation Angle: Computed Tomography Validation of Angle Bisector Method

Cortices of Fibula and Tibia Can Provide Landmarks for Accurate Syndesmotic Fixation Angle: Computed Tomography Validation of Angle Bisector Method

More 2023 ISAKOS Congress Content