Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

Anthony A. Pollizzi, Daniel C. Herman, Gregory C. Berlet, Christopher W. Reb

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: When intraoperative computed tomography (CT) is unavailable, open syndesmosis assessment is a universally available, safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved upon with a validated technique for assessing the accuracy of open syndesmosis reductions. The “tibiofibular line” (TFL) is a CT-based technique found to be sensitive for malreduction. The purpose of this study was to assess the feasibility of adapting the CT-TFL method into a reliable intraoperative open technique by refining the methodology of previous work exploring the clinical TFL technique. Methods: Three observers were instructed to clinically simulate the TFL on cadaveric lower limbs. For each specimen, observers repeated and recorded 3 clinical TFL measurements for each of 4 measurement series representing different degrees of fibula reduction. Intraclass correlation was used to assess intra- and interobserver reliabilities. Results: Mean intraobserver reliability was.88. Mean interobserver reliability was.75. Both intra- and interobserver reliabilities were highest for anatomic syndesmosis reduction. Conclusion: The findings of excellent to near perfect intraobserver and good to excellent interobserver reliability indicate the feasibility of translating the CT-TFL into a reliable open technique. Levels of Evidence: Level III: Diagnostic study.

Original languageEnglish (US)
Pages (from-to)516-521
Number of pages6
JournalFoot and Ankle Specialist
Issue number6
StatePublished - Dec 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Podiatry
  • Orthopedics and Sports Medicine


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