Acute and Chronic Syndesmotic Instability

Treatment of the Deltoid and Syndesmotic Ligaments in Chronic Ankle Instability

“…More recently, weight-bearing computed tomography has become particularly effective in diagnosing diastasis and is currently the most sensitive imaging modality for detecting subtle syndesmotic malalignment, especially postoperatively in the setting of metal implants. [53][54][55] MRI may provide utility in diagnosing chronic disruption of the syndesmotic complex and/or deltoid; however, it fails to identify dynamic instability. 42 The lambda sign noted on coronal MRI sequences has been shown to be both sensitive and specific for syndesmotic injuries involving greater than 2 mm of diastasis seen on arthroscopic stress examination.…”

“…11 Classification for syndesmotic injuries have been described in the literature; however, they are not commonly used in clinical practice. 39,40,57 More commonly employed is a simple grading system with grade 1 representing a symptomatic but stable syndesmotic injury with normal radiographs; grade 2 a partial syndesmotic disruption; and grade III injury to the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), intermembrane (IOL), deltoid ligament, and clear disruption of anatomic relationships. 57 Over the last few years there has been an increasing body of literature to support the use of arthroscopy in the diagnosis of deltoid and/or syndesmotic instability.…”

“…39,40,57 More commonly employed is a simple grading system with grade 1 representing a symptomatic but stable syndesmotic injury with normal radiographs; grade 2 a partial syndesmotic disruption; and grade III injury to the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), intermembrane (IOL), deltoid ligament, and clear disruption of anatomic relationships. 57 Over the last few years there has been an increasing body of literature to support the use of arthroscopy in the diagnosis of deltoid and/or syndesmotic instability. 31,45,58,59 Arthroscopy can not only be utilized in the diagnosis and treatment of chronic ankle instability but concomitant intra-articular pathology such as impingement and associated cartilage lesions can also be addressed in the same setting.…”

“…Computed tomography can be particularly helpful for assessing malreduction of concomitant fibular fractures and/or malreduction of the syndesmosis as well as interposed calcified tissue. More recently, weight-bearing computed tomography has become particularly effective in diagnosing diastasis and is currently the most sensitive imaging modality for detecting subtle syndesmotic malalignment, especially postoperatively in the setting of metal implants 53–55. MRI may provide utility in diagnosing chronic disruption of the syndesmotic complex and/or deltoid; however, it fails to identify dynamic instability 42.…”

Comparison of Several Combinations of Suture Tape Reinforcement and Suture Button Constructs for Fixation of Unstable Syndesmosis

“…9 The technique was previously described by Teramoto et al, 12 and some authors recommend STR as an augment fixation for both acute and chronic syndesmotic injuries. 13 The aim of this study was to evaluate syndesmotic stability after fixation with several combinations of SB and STR constructs in a cadaver model previously proven to be unstable. We hypothesized that STR would significantly add to stability of the SB constructs in the complete syndesmotic instability model produced by transection of ATFL, interosseous ligament (IOL), and posterior inferior tibiofibular ligament (PITFL).…”