Advanced Imaging in Orthopedic Biomechanics

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 17105

Special Issue Editors


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Guest Editor
Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
Interests: biomechanics of lower limb joints and human locomotion; computer assisted surgery in orthopedics; personalized treatments in orthopedics; 3D printing in musculoskeletal surgery; human motion tracking via gait analysis and 3D video-fluoroscopy; medical imaging in biomechanical evaluations

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Guest Editor
Department of Mechanical Engineering, Drexel University, Philadelphia, PA 19104, USA
Interests: Image-based modelling; surgical planning; personalized orthopedic implants

Special Issue Information

Dear Colleagues,

Recent advancements in medical imaging, such as weight-bearing and dual-energy computer tomography, 3-5 Tesla magnetic resonance devices, and elastography, produce high-resolution visualization, high speed of accusation under functional conditions, reduced radiation, and decreased cost. These and other, similar factors have made advanced imaging techniques not only popular as clinical diagnostic tools but also an integral part of many orthopedic biomechanics research studies. Numerous examples of this exist, including image-based personalized surgical planning, development of high-fidelity computer models, computer-aided surgery, personalized implant design and development, functional-imaging-based diagnosis, biomechanics-inspired advanced imaging techniques, and advanced 3D printing applications. This Special Issue aims to collect studies where orthopedic biomechanics is highly supported by advanced medical imaging. You are invited to contribute original research papers, methodological advances, mini-reviews, and perspective articles. Articles on both advanced imaging in orthopedic biomechanics or innovative applications of conventional imaging methods in orthopedic biomechanics are welcomed.

Dr. Claudio Belvedere
Dr. Sorin Siegler
Guest Editors

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Keywords

  • medical imaging
  • biomechanics
  • othopedics
  • computer tomography
  • magnetic resonance
  • joint modeling
  • joint prosthesis design
  • orthopedic diagnosis

Published Papers (11 papers)

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Research

Jump to: Review

13 pages, 3845 KiB  
Article
The Spatial Characteristics of Intervertebral Foramina within the L4/L5 and L5/S1 Motor Segments of the Spine
by Piotr Nowak, Mikołaj Dąbrowski, Adam Druszcz and Łukasz Kubaszewski
Appl. Sci. 2024, 14(6), 2263; https://doi.org/10.3390/app14062263 - 7 Mar 2024
Viewed by 615
Abstract
The prevalence of lower back pain and radicular pain in the population requires more and more accurate diagnostic methods to more effectively prevent and treat patients with these ailments. In this paper, we focused on one of the causes of lower back pain [...] Read more.
The prevalence of lower back pain and radicular pain in the population requires more and more accurate diagnostic methods to more effectively prevent and treat patients with these ailments. In this paper, we focused on one of the causes of lower back pain and radicular pain—lumbar foraminal stenosis (LFS). The aim of the study is to assess the morphometry of the intervertebral canals in the lumbar spine at the levels of the L4/L5 and L5/S1 motor segments. The obtained results showed correlations between the circumference and the surface area on individual cross-sections of the intervertebral canals at the L4/L5 and L5/S1 levels and determined the approximate shape of the root canal and its variability. On this basis, we were able to determine the influences of the patient’s age and sex on the morphometric parameters of the intervertebral canals at the L4/L5 and L5/S1 levels. Further research is needed in this area, taking into account additional factors influencing the shape of intervertebral canals. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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21 pages, 15814 KiB  
Article
Biomechanical Evaluation of Plantar Pressure Distribution towards a Customized 3D Orthotic Device: A Methodological Case Study through a Finite Element Analysis Approach
by Jesus Alejandro Serrato-Pedrosa, Guillermo Urriolagoitia-Sosa, Beatriz Romero-Ángeles, Guillermo Manuel Urriolagoitia-Calderón, Salvador Cruz-López, Alejandro Urriolagoitia-Luna, David Esaú Carbajal-López, Jonathan Rodolfo Guereca-Ibarra and Guadalupe Murillo-Aleman
Appl. Sci. 2024, 14(4), 1650; https://doi.org/10.3390/app14041650 - 18 Feb 2024
Cited by 1 | Viewed by 1440
Abstract
Plantar pressure distribution is a thoroughly recognized parameter for evaluating foot structure and biomechanical behavior, as it is utilized to determine musculoskeletal conditions and diagnose foot abnormalities. Experimental testing is currently being utilized to investigate static foot conditions using invasive and noninvasive techniques. [...] Read more.
Plantar pressure distribution is a thoroughly recognized parameter for evaluating foot structure and biomechanical behavior, as it is utilized to determine musculoskeletal conditions and diagnose foot abnormalities. Experimental testing is currently being utilized to investigate static foot conditions using invasive and noninvasive techniques. These methods are usually expensive and laborious, and they lack valuable data since they only evaluate compressive forces, missing the complex stress combinations the foot undergoes while standing. The present investigation applied medical and engineering methods to predict pressure points in a healthy foot soft tissue during normal standing conditions. Thus, a well-defined three-dimensional foot biomodel was constructed to be numerically analyzed through medical imaging. Two study cases were developed through a structural finite element analysis. The first study was developed to evaluate barefoot behavior deformation and stresses occurring in the plantar region. The results from this analysis were validated through baropodometric testing. Subsequently, a customized 3D model total-contact foot orthosis was designed to redistribute peak pressures appropriately, relieving the plantar region from excessive stress. The results in the first study case successfully demonstrated the prediction of the foot sole regions more prone to suffer a pressure concentration since the values are in good agreement with experimental testing. Employing a customized insole proved to be highly advantageous in fulfilling its primary function, reducing peak pressure points substantially. The main aim of this paper was to provide more precise insights into the biomechanical behavior of foot pressure points through engineering methods oriented towards innovative assessment for absolute customization for orthotic devices. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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15 pages, 8203 KiB  
Article
Numerical Evaluation Using the Finite Element Method on Frontal Craniocervical Impact Directed at Intervertebral Disc Wear
by Alfonso Trejo-Enriquez, Guillermo Urriolagoitia-Sosa, Beatriz Romero-Ángeles, Miguel Ángel García-Laguna, Martín Guzmán-Baeza, Jacobo Martínez-Reyes, Yonatan Yael Rojas-Castrejon, Francisco Javier Gallegos-Funes, Julián Patiño-Ortiz and Guillermo Manuel Urriolagoitia-Calderón
Appl. Sci. 2023, 13(21), 11989; https://doi.org/10.3390/app132111989 - 2 Nov 2023
Cited by 1 | Viewed by 1181
Abstract
Traumatic cervical pathology is an injury that emerges due to trauma or being subjected to constant impact loading, affecting the ligaments, muscles, bones, and spinal cord. In contact sports (the practice of American football, karate, boxing, and motor sports, among others), the reporting [...] Read more.
Traumatic cervical pathology is an injury that emerges due to trauma or being subjected to constant impact loading, affecting the ligaments, muscles, bones, and spinal cord. In contact sports (the practice of American football, karate, boxing, and motor sports, among others), the reporting of this type of injury is very common. Therefore, it is imperative to have preventive measures so players do not suffer from such injuries, since bad practices or accidents can put their lives at risk. This research evaluated cervical and skull biomechanical responses during a frontal impact, taking into consideration injury caused by wear on the intervertebral disc. Intervertebral disc wear is a degenerative condition that affects human mobility; it is common in people who practice contact sports and it can influence the response of the cervical system to an impact load. The main objective of this work is to evaluate the effects caused by impact loading and strains generated throughout the bone structure (composed of the skull and the cervical spine). The numerical evaluation was developed using the finite element method and the construction of the biomodel from computational axial tomography. In addition, the numerical simulation allowed us to observe how the intervertebral disc’s wear affected the cervical region’s biomechanical response. In addition, a comparison could be made between a healthy system and a disc that had suffered wear. Finally, the analysis provided information valuable to understanding how an impact, force-related injury can be affected and enabled us to propose better physiotherapeutic procedures. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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18 pages, 7036 KiB  
Article
Numerical Analysis Applying the Finite Element Method by Developing a Complex Three-Dimensional Biomodel of the Biological Tissues of the Elbow Joint Using Computerized Axial Tomography
by Daniel Maya-Anaya, Guillermo Urriolagoitia-Sosa, Beatriz Romero-Ángeles, Miguel Martinez-Mondragon, Jesús Manuel German-Carcaño, Martin Ivan Correa-Corona, Alfonso Trejo-Enríquez, Arturo Sánchez-Cervantes, Alejandro Urriolagoitia-Luna and Guillermo Manuel Urriolagoitia-Calderón
Appl. Sci. 2023, 13(15), 8903; https://doi.org/10.3390/app13158903 - 2 Aug 2023
Cited by 3 | Viewed by 1127
Abstract
Numerical analysis computational programs are applied to the research of biological tissues, which have complex forms. Continuous technological advance has facilitated the development of biomodels to evaluate biological tissues of different human body systems using computerized axial tomography to produce complex three-dimensional models [...] Read more.
Numerical analysis computational programs are applied to the research of biological tissues, which have complex forms. Continuous technological advance has facilitated the development of biomodels to evaluate biological tissues of different human body systems using computerized axial tomography to produce complex three-dimensional models that represent the morphological and physiological characteristics of the real tissues. Biomodels are applied to numerical analysis using the Finite Element Method and provide a perspective of the mechanical behavior in the system. In this study, a numerical evaluation was performed by developing a biomodel of the humerus, radius, and ulna (the elbow joint, composed of cortical bone, trabecular bone, and cartilage). Also introduced to the biomodel were the ligaments of the capsule joint, collateral ligaments of the ulna, and collateral ligaments of the radius. The biomodel was imported into a computer program to perform a numerical analysis considering the mechanical properties of cortical and trabecular bone (including elasticity modulus, shear modulus, Poisson relation, and density). The embedding conditions were defined to restrict displacements and rotations in the proximal zone of the humerus, applying a compression load to the other end of the biomodel at the distal area of the radius and ulna. The results are the direct consequence of how boundary conditions and external agents are applied to the structure to be analyzed, and the data obtained show how the behavior of the force applied through the component produces stresses and strains as a whole, as well as for each of the components. These stresses and strains can indicate zones with structural problems and the detection areas causing pain (assisting in a better diagnosis). Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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13 pages, 2401 KiB  
Article
Biomechanical Analysis of Femoral Stem Features in Hinged Revision TKA with Valgus or Varus Deformity: A Comparative Finite Elements Study
by Edoardo Bori and Bernardo Innocenti
Appl. Sci. 2023, 13(4), 2738; https://doi.org/10.3390/app13042738 - 20 Feb 2023
Viewed by 1202
Abstract
Hinged total knee arthroplasty (TKA) is a valid option to treat patients during revision of an implant; however, in case of varus/valgus deformity, the force transmission from the femur to the tibia could be altered and therefore the performance of the implant could [...] Read more.
Hinged total knee arthroplasty (TKA) is a valid option to treat patients during revision of an implant; however, in case of varus/valgus deformity, the force transmission from the femur to the tibia could be altered and therefore the performance of the implant could be detrimental. To be able to evaluate this, the goal of this study was to investigate, using a validated finite element analysis, the effect of varus/valgus load configurations in the bones when a hinged TKA is used. In detail, short and long stem lengths (50 mm, and 120 mm), were analyzed both under cemented or press-fit fixation under the following varus and valgus deformity: 5°, 10°, 20°, and 30°. The main outputs of the study were average bone stress in different regions of interest, together with tibio-femoral contact pressure and force. Results demonstrated that changes in the varus or valgus deformity degrees induce a change in the medio-lateral stress and force distribution, together with a change in the contact area. The effect of stem length and cement do not alter the tibio-femoral contact biomechanics but its effect is mainly localized in the distal femoral region, and it is negligible in the proximal regions. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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12 pages, 11230 KiB  
Article
In-Vivo Quantification of Knee Deep-Flexion in Physiological Loading Condition trough Dynamic MRI
by Michele Conconi, Filippo De Carli, Matteo Berni, Nicola Sancisi, Vincenzo Parenti-Castelli and Giuseppe Monetti
Appl. Sci. 2023, 13(1), 629; https://doi.org/10.3390/app13010629 - 3 Jan 2023
Cited by 1 | Viewed by 1676
Abstract
The in-vivo quantification of knee motion in physiological loading conditions is paramount for the understanding of the joint’s natural behavior and the comprehension of articular disorders. Dynamic MRI (DMRI) represents an emerging technology that makes it possible to investigate the functional interaction among [...] Read more.
The in-vivo quantification of knee motion in physiological loading conditions is paramount for the understanding of the joint’s natural behavior and the comprehension of articular disorders. Dynamic MRI (DMRI) represents an emerging technology that makes it possible to investigate the functional interaction among all the joint tissues without risks for the patient. However, traditional MRI scanners normally offer a reduced space of motion, and complex apparatus are needed to load the articulation, due to the horizontal orientation of the scanning bed. In this study, we present an experimental and computational procedure that combines an open, weight-bearing MRI scanner with an original registration algorithm to reconstruct the three-dimensional kinematics of the knee from DMRI, thus allowing the investigation of knee deep-flexion under physiological loads in space. To improve the accuracy of the procedure, an MR-compatible rig has been developed to guide the knee flexion of the patient. We tested the procedure on three volunteers. The overall rotational and positional accuracy achieved are 1.8° ± 1.4 and 1.2 mm ± 0.8, respectively, and they are sufficient for the characterization of the joint behavior under load. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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9 pages, 3793 KiB  
Article
Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex
by Elena Campagnoli, Sorin Siegler, Maria Ruiz, Alberto Leardini and Claudio Belvedere
Appl. Sci. 2022, 12(10), 5087; https://doi.org/10.3390/app12105087 - 18 May 2022
Viewed by 1221
Abstract
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and [...] Read more.
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and insertion site definitions obtained with different magnetic resonance imaging (MRI) modalities on the mechanical behaviour of a dynamic model of the ankle complex. Methods. MRI scans, both via 1.5 T and 3.0 T, were performed on a lower-limb specimen, free from anatomical defects, to obtain morphological information on ligament-to-bone attachment sites. This specimen was used previously to develop the dynamic model. A third ligament attachment site mapping scheme was based on anatomical dissection of the scanned specimen. Following morphological comparison of the ligament attachment sites, their effect on the mechanical behaviour of the ankle complex, expressed by three-dimensional load–displacement properties, was assessed through the model. Results. Large differences were observed in the subtalar ligament attachment sites between those obtained through the two MRI scanning modalities. The 3.0 T MRI mapping was more consistent with dissection than the 1.5 T MRI. Load–displacement curves showed similar mechanical behaviours between the three mappings in the frontal plane, but those obtained from the 3.0 T MRI mapping were closer to those obtained from dissection. Conclusions. The state-of-the-art 3.0 T MRI image analysis resulted in more realistic mapping of ligament fibre origin and insertion site definitions; corresponding load–displacement predictions from a subject-specific model of the ankle complex showed a mechanical behaviour more similar to that using direct ligament attachment observations. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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10 pages, 1914 KiB  
Article
Aging Alters Cervical Vertebral Bone Density Distribution: A Cross-Sectional Study
by Eun-Sang Moon, Seora Kim, Nathan Kim, Minjoung Jang, Toru Deguchi, Fengyuan Zheng, Damian J. Lee and Do-Gyoon Kim
Appl. Sci. 2022, 12(6), 3143; https://doi.org/10.3390/app12063143 - 19 Mar 2022
Cited by 1 | Viewed by 1682
Abstract
Osteoporosis reduces bone mineral density (BMD) with aging. The incidence of cervical vertebral injuries for the elderly has increased in the last decade. Thus, the objective of the current study was to examine whether dental cone beam computed tomography (CBCT) can identify age [...] Read more.
Osteoporosis reduces bone mineral density (BMD) with aging. The incidence of cervical vertebral injuries for the elderly has increased in the last decade. Thus, the objective of the current study was to examine whether dental cone beam computed tomography (CBCT) can identify age and sex effects on volumetric BMD and morphology of human cervical vertebrae. A total of 136 clinical CBCT images were obtained from 63 male and 73 female patients (20 to 69 years of age). Three-dimensional images of cervical vertebral bodies (C2 and C3) were digitally isolated. A gray level, which is proportional to BMD, was obtained and its distribution was analyzed in each image. Morphology, including volume, heights, widths, and concavities, was also measured. Most of the gray level parameters had significantly higher values of C2 and C3 in females than in males for all age groups (p < 0.039). The female 60-age group had significant lower values of Mean and Low5 of C2 and C3 than both female 40- and 50-age groups (p < 0.03). The reduced BMD of the female 60-age group likely resulted from postmenopausal demineralization of bone. Current findings suggest that dental CBCT can detect age-dependent changes of cervical vertebral BMD, providing baseline information to develop an alternative tool to diagnose osteoporosis. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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12 pages, 3470 KiB  
Article
A Pelvic Reconstruction Procedure for Custom-Made Prosthesis Design of Bone Tumor Surgical Treatments
by Gilda Durastanti, Claudio Belvedere, Miriana Ruggeri, Davide Maria Donati, Benedetta Spazzoli and Alberto Leardini
Appl. Sci. 2022, 12(3), 1654; https://doi.org/10.3390/app12031654 - 4 Feb 2022
Cited by 5 | Viewed by 2585
Abstract
In orthopaedic oncology, limb salvage procedures are becoming more frequent thanks to recent major improvements in medical imaging, biomechanical modelling and additive manufacturing. For the pelvis, surgical reconstruction with metal implants after tumor resection remains challenging, because of the complex anatomical structures involved. [...] Read more.
In orthopaedic oncology, limb salvage procedures are becoming more frequent thanks to recent major improvements in medical imaging, biomechanical modelling and additive manufacturing. For the pelvis, surgical reconstruction with metal implants after tumor resection remains challenging, because of the complex anatomical structures involved. The aim of the present work is to define a consistent overall procedure to guide surgeons and bioengineers for proper implant design. All relevant steps from medical imaging to an accurate 3D anatomical-based model are here reported. In detail, the anatomical 3D models include bone shapes from CT on the entire pelvic bone, i.e., including both affected and unaffected sides, and position and extension of the tumor and soft tissues from MRI on the affected side. These models are then registered in space, and an initial shape of the personalized implant for the affected side can be properly designed and dimensioned based on the information from the unaffected side. This reported procedure can be fundamental also for virtual pre-surgical planning, and the design of patient-specific cutting guides, which would result is a safe margin for tumor cut. The entire procedure is here shown by describing the results in a single real case. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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Review

Jump to: Research

22 pages, 933 KiB  
Review
Spine Deformity Assessment for Scoliosis Diagnostics Utilizing Image Processing Techniques: A Systematic Review
by Nurhusna Najeha Amran, Khairul Salleh Basaruddin, Muhammad Farzik Ijaz, Haniza Yazid, Shafriza Nisha Basah, Nor Amalina Muhayudin and Abdul Razak Sulaiman
Appl. Sci. 2023, 13(20), 11555; https://doi.org/10.3390/app132011555 - 22 Oct 2023
Viewed by 1533
Abstract
Spinal deformity refers to a range of disorders that are defined by anomalous curvature of the spine and may be classified as scoliosis, hypo/hyperlordosis, or hypo/hyperkyphosis. Among these, scoliosis stands out as the most common type of spinal deformity in human beings, and [...] Read more.
Spinal deformity refers to a range of disorders that are defined by anomalous curvature of the spine and may be classified as scoliosis, hypo/hyperlordosis, or hypo/hyperkyphosis. Among these, scoliosis stands out as the most common type of spinal deformity in human beings, and it can be distinguished by abnormal lateral spine curvature accompanied by axial rotation. Accurate identification of spinal deformity is crucial for a person’s diagnosis, and numerous assessment methods have been developed by researchers. Therefore, the present study aims to systematically review the recent works on spinal deformity assessment for scoliosis diagnosis utilizing image processing techniques. To gather relevant studies, a search strategy was conducted on three electronic databases (Scopus, ScienceDirect, and PubMed) between 2012 and 2022 using specific keywords and focusing on scoliosis cases. A total of 17 papers fully satisfied the established criteria and were extensively evaluated. Despite variations in methodological designs across the studies, all reviewed articles obtained quality ratings higher than satisfactory. Various diagnostic approaches have been employed, including artificial intelligence mechanisms, image processing, and scoliosis diagnosis systems. These approaches have the potential to save time and, more significantly, can reduce the incidence of human error. While all assessment methods have potential in scoliosis diagnosis, they possess several limitations that can be ameliorated in forthcoming studies. Therefore, the findings of this study may serve as guidelines for the development of a more accurate spinal deformity assessment method that can aid medical personnel in the real diagnosis of scoliosis. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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17 pages, 3320 KiB  
Review
Ins and Outs of the Ankle Syndesmosis from a 2D to 3D CT Perspective
by Thibaut Dhont, Manu Huyghe, Matthias Peiffer, Noortje Hagemeijer, Bedri Karaismailoglu, Nicola Krahenbuhl, Emmanuel Audenaert and Arne Burssens
Appl. Sci. 2023, 13(19), 10624; https://doi.org/10.3390/app131910624 - 23 Sep 2023
Viewed by 1487
Abstract
Despite various proposed measurement techniques for assessing syndesmosis integrity, a standardized protocol is lacking, and the existing literature reports inconsistent findings regarding normal and abnormal relationships between the fibula and tibia at the distal level. Therefore, this study aims to present an overview [...] Read more.
Despite various proposed measurement techniques for assessing syndesmosis integrity, a standardized protocol is lacking, and the existing literature reports inconsistent findings regarding normal and abnormal relationships between the fibula and tibia at the distal level. Therefore, this study aims to present an overview of two- (2D) and three-dimensional (3D) measurement methods utilized to evaluate syndesmosis integrity. A topical literature review was conducted, including studies employing 2D or 3D measurement techniques to quantify distal tibiofibular syndesmosis alignment on computed tomography (CT) or weight-bearing CT (WBCT) scans. A total of 49 eligible articles were included in this review. While most interclass correlation (ICC) values indicate favorable reliability, certain measurements involving multiple steps exhibited lower ICC values, potentially due to the learning curve associated with their implementation. Inconclusive results were obtained regarding the influence of age, sex, and height on syndesmotic measurements. No significant difference was observed between bilateral ankles, permitting the use of the opposite side as an internal control for comparison. There is a notable range of normal and pathological values, as evidenced by the standard deviation associated with each measurement. This review highlights the absence of a consensus on syndesmotic measurements for assessing integrity despite numerous CT scan studies. The diverse measurement techniques, complexity, and inconclusive findings present challenges in distinguishing between normal and pathological values in routine clinical practice. Promising advancements in novel 3D techniques offer potential for automated measurements and reduction of observer inaccuracies, but further validation is needed. Full article
(This article belongs to the Special Issue Advanced Imaging in Orthopedic Biomechanics)
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