Syndesmosis Injury From Diagnosis to Repair

Physical Examination, Diagnosis, and Arthroscopic-Assisted Reduction

Jeffrey Wake, DO; Kevin D. Martin, DO, FAAOS

Disclosures

J Am Acad Orthop Surg. 2020;28(13):517-527. 

In This Article

Abstract and Introduction

Abstract

Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.

Introduction

Two types of ankle ligament injuries exist, collateral and syndesmotic. Most ankle ligament injuries occur to the collateral ligaments: anterior talofibular ligament (ATFL), calcaneofibular ligament, and deltoid ligament. In general, the collateral ligaments heal with sufficient scar to reestablish coronal stability and adequate ankle function. Not all ankle ligament injuries are to the collateral ligaments—the syndesmotic ligaments can also be injured leading to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The tibiofibular syndesmosis is a complex of well-described ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. We propose a simplified start-to-finish written and video guide to physical examination, diagnosis, arthroscopic reduction, and internal fixation of isolated syndesmosis injuries based on the past and present literature.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....