Syndesmosis reduction by computer-assisted orthopaedic surgery with navigation: Feasibility and accuracy in a cadaveric study

Introduction: Syndesmotic disruption may be difficult to reduce and fix, and malreduction is associated with inferior outcomes. Intraoperative computed tomography (CT) can provide accurate assessment of syndesmotic reduction. We hypothesized that three-dimensional (3-D) computer-assisted orthopaedic surgery (CAOS) with navigation of syndesmotic reduction could avoid malreduction. Our goal was to assess feasibility and accuracy of such a technic in a cadaveric study. Method: Eleven through-the-knee cadaveric specimens were used. Ankle CT as control was obtained prior to intervention. The syndesmosis was destabilized by sectioning the tibiofibular ligaments, producing a malreduction temporarily fixed with a Kirschner wire (K-wire). With reference base fixed to the tibia an acquisition scan was made. A K-wire was fixed to the fibula. The K-wire holding the syndesmosis malreduced was removed. The fibula was reduced within the syndesmosis under 3-D CAOS using a navigated K-wire. Once optimal position was obtained by referencing control images, the syndesmosis was fixed with a 3.5 mm screw. A CT scan was performed to assess quality of reduction. Results: Position of the fibula in control and post-reduction CT scans showed a mean anterior-posterior displacement of 0.74 (+/- 0.62) mm. The medial-lateral position measured a mean displacement of 0.68 (+/- 0.76) mm. Rotation of the fibula revealed a mean difference of 0.99 degrees (+/- 0.73). Conclusion: In this cadaveric study, CAOS with navigation allowed for very accurate syndesmosis reduction. This appears to be a promising technique to be confirmed by clinical study. (C) 2016 Elsevier Ltd. All rights reserved.