Acute and Chronic Injuries to the Syndesmosis

Stable and unstable grade II syndesmotic injuries require different treatment strategies and vary in functional outcomes: a systematic review

“…Second, difficulty exists in delineating grade I from stable grade II, and stable from unstable grade II injuries 13 54. A reflection of this shortcoming is the relatively large amount of studies we had to exclude from this review because the grade of the syndesmotic injury could not be defined on the basis of the diagnostic methods that were used 1 16–27.…”

Current trends in the diagnosis and management of syndesmotic injury

“…The IOL spans and connects most of the tibia and fibula. It is a pyramidal thickening of the distal membrane that ends just superior to the ATIFL and PITFL, which helps stabilize the talocrural joint during loading [3]. Although not specifically a part of the syndesmosis, disruption of the deltoid ligament is a frequently encountered finding with syndesmotic injuries.…”

“…Their primary function is to stabilize the proximal and, in particular, distal associations between the tibia and fibula-the latter comprising the important bony mortise of the ankle. The AITFL is a multilayer ligament that extends obliquely from the anterolateral tubercle of the distal tibia, 5 mm above the plafond, to the longitudinal tubercle on the anterior portion of the lateral malleolus [3]. The PITFL consists of two layers-deep and superficial.…”

“…At about 4-6 weeks post-injury, patients can be placed into a lace-up ankle brace and begin a more intensive functional rehabilitative program guided by symptom tolerance [3]. For more significant stable syndesmotic injuries, the lace-up brace should be worn for six more weeks to minimize symptoms [3].…”

“…This includes rest, elevation, compression, and anti-inflammatory medication. Treatment also can include therapeutic modalities such as electric stimulation and massage [3]. At about 4-6 weeks post-injury, patients can be placed into a lace-up ankle brace and begin a more intensive functional rehabilitative program guided by symptom tolerance [3].…”