Purpose: Stress radiographs have long been used to evaluate chronic lateral ankle instability. Several measurement methods exist, but their diagnostic value remains controversial. This paper introduces a new measurement method for stress radiographs, the fibular tip to talar neck (FTN) method, and compares it with established methods to assess its diagnostic accuracy and reliability. Materials and Methods: Forty-one patients who underwent a modified Broström procedure for chronic lateral ankle instability were included. Lateral standing and anterior drawer radiographs were analyzed using two conventional methods (methods I and II) and the novel FTN method. The contralateral unaffected side served as an internal control. The diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The intra-observer and inter-observer reliability were assessed using intraclass correlation coefficients (ICCs). Results: Using the FTN method, the mean gap on the affected side (14.39±4.79 mm) was significantly greater than on the contralateral side (10.24±4.19 mm, p<0.001). The side-to-side difference (SSD) was significantly higher in the FTN method (4.14±2.94 mm) compared to methods I (0.89±1.94 mm) and II (0.91±1.78 mm, p<0.001). The FTN method showed a balanced diagnostic performance with an area under the curve of 0.743 and an optimal cut-off of 13.5 mm. The intra-observer and inter-observer reliability were good for all methods. The intra-observer and inter-observer ICCs for the FTN method were 0.858 and 0.783, respectively. Conclusion The FTN method provides a reliable and reproducible measure of chronic lateral ankle instability. The method facilitates a more intuitive diagnosis compared to conventional techniques by providing a larger numerical differentiation (SSD) and a statistically balanced threshold.

We presented the case of a 60-year-old man with an unexpected complication of acromial osteolysis with subsequent regeneration of the acromion. To our knowledge, this case report represents the first description of the regeneration of acromion after osteolysis. He underwent open reduction and internal fixation with a novel hybrid hook locking compression plate 6 days after the injury. No procedure was undertaken for the coracoclavicular ligament in this case. Five months after internal fixation with a hook plate, the patient underwent surgery for the removal of the hook plate. Radiographs after removal of the hook plate showed erosion of the acromion. We decided to perform a conservative treatment for acromion osteolysis and observed the progress. A final radiograph that was obtained 10 months after hook plate removal shows regeneration of the acromion. We thought that the periosteum played a significant role in the acromion regeneration despite no special treatment.