Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report

Abstract

Background/aimThe distal tibiofibular joint is described as a syndesmosis. Traditionally, severe syndesmotic injuries with diastasis have been treated surgically with screw fixation. This case series details an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. The aim of this study was to describe players’ journey from injury, through diagnosis to surgery, rehabilitation and return to participation, detailing time scales and methods used at each stage to highlight the change in current practice.MethodsPlayers were identified via a single orthopaedic surgeon in the UK who specialises in ankle syndesmosis repair. Between January 2010 and September 2015, adult men playing full-time professional rugby league in the UK Super League with ankle syndesmosis injuries were identified.ResultsEighteen players from six different clubs were included. The most common mechanism of injury was forced dorsiflexion/eversion. The average return to participation was 64 days (SD 17.2, range 38–108). This compares favourably to reports of between 120 and 180 days following screw fixation.ConclusionAnkle syndesmosis tightrope repair and an accelerated rehabilitation protocol is as safe as traditional methods. The accelerated rehabilitation protocol promotes early weight-bearing and has shown to expedite the return to sport for professional Rugby League players. It is possible to return to sport 2 months after a tightrope repair and accelerated rehabilitation, compared with 3–6 months post screw fixation. This is extremely encouraging for the professional sporting population.

Ankle Syndesmotic Injury Repair with Tightrope

“…Hunt et al [10] suggested 70-84 days is the likely RTP time frame with their preferred method of suture button fixation. Alex Latham [11] in his case series suggested return to sport is possible within 61 days following syndesmosis injury, provided surgery with tightrope and rehabilitation is uncomplicated.…”

The sporting ankle: an update

“…There is evidence to suggest that the burden from high ankle sprains is greater than previously thought, with incidence quoted as high as 18% of all ankle sprains and result in greater levels of pain, treatment and lost sports time than lateral sprains. 15 The syndesmosis consists of a complex of anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), the interosseous ligament and the transverse tibiofibular ligament. Mechanism of injury is usually internal rotation of the leg with forced external rotation of the talus and foot.…”

Evidenzlage zur konservativen Therapie bei akuter Syndesmosenverletzung am oberen Sprunggelenk im Sport

“…Von den 11 eingeschlossenen Studien lieferten nur Lin et al [14], Pajaczkowski [15] und Knapik et al [19] eine genaue Einteilung der Schweregrade der Verletzung. Dies muss kritisch betrachtet werden, da die anderen Arbeiten bei der Einordnung des Verletzungsgrades nicht auf die standardisierte Klassifikation der Syndesmosenverletzung verwiesen, sondern allgemeine Formulierungen wie "leicht", "mittel" und "schwer" verwendeten [18] [27]. Dadurch lassen sich die Rehabilitationsprotokolle nicht im direkten Vergleich gegenüberstellen, da die Interventionsgruppen nicht einheitlich zusammengefasst werden können.…”