APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 1: Clinical Manifestation, Radiologic Examination, Diagnosis Criteria, Classification, and Nonoperative Treatment

Abstract

Background: Clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies regarding chronic syndesmosis injury remain unclear. Purpose: An international group of experts representing the fields of sports injuries in the foot and ankle area were invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injuries. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). Study Design: Consensus statement. Methods: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 15 clinical questions and statements were related to the clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies for chronic syndesmosis injury and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: Of the 15 questions and statements, 5 reached unanimous support and 10 achieved strong consensus. Conclusion: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with diagnosis, classification, and nonoperative treatment strategies for chronic syndesmosis injury.

Treatment of the Deltoid and Syndesmotic Ligaments in Chronic Ankle Instability

“…Patients in both treatment arms of this study demonstrate increased AOFAS hindfoot scores from baseline irrespective of transfixation at the time of arthroscopic debridement (Group 1 AOFAS hindfoot score 52 pre-op to 87 post-op vs group 2 AOFAS hindfoot score 63-90) without any significant difference among the two (P = 0.6453). 55 No complications were reported in either treatment arm.…”

“…A recent census statement (2021) from Asia-Pacific Knee Arthroscopy Sports Medicine Society (APKASS) including 111 leading experts agreed on a 3.0 mm as a cutoff for syndesmosis injury with 76.2% agreement. 55 Arthroscopic treatment typically requires debridement of reactive synovitis to visualize and reduce the syndesmosis followed by assessment of reduction of the syndesmosis in both the coronal and plane. In the coronal plane reduction anatomic when diastasis between the fibula and tibia is less than 1 mm, meaning the probe cannot be placed within the syndesmosis.…”

“…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.…”

“…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.…”

Prevalence of ankle instability in performers of Chinese classical dance: a cross-sectional study of 105 Chinese dancers

“…Further studies on the biomechanics of Chinese Open access dance can be done for more objective analyses with quantification of mechanical instability and accounting of differential diagnoses such as syndesmosis instability to be ruled out. [41][42][43][44][45] In addition, a greater focus on the specific risk factors predisposing Chinese dancers to CAI should be explored.…”