Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines

Dijk, C. Niek van; Longo, Umile Giuseppe; Loppini, Mattia; Florio, Pino; Maltese, Ludovica; Ciuffreda, Mauro; Denaro, Vincenzo

doi:10.1007/s00167-015-3942-8

Cited by 111 publications

(114 citation statements)

References 62 publications

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“…5 The European Society of Sports Traumatology, Knee Surgery and Arthroscopy-Ankle and Foot Associates (ESSKA-AFAS) recommends the clinical tests: tenderness on palpation over the anterior tibiofibular ligament, the fibular translation test and the Cotton test. 38 Those used in the current study included ability to hop, tenderness to palpation over the syndesmosis, external rotation test and the squeeze test, as suggested by Smam et al 10 In all cases, the injury was observed by medical professionals.…”

Section: Discussionmentioning

confidence: 99%

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

Latham

Goodwin

Stirling³

et al. 2017

BMJ Open Sport Exerc Med

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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.

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Section: Discussionmentioning

confidence: 99%

“…38 Further classification would be valuable in determining the grade of injury according to severity and aid prognosis and management planning. Causal relationships and predictions between preseason status, previous injury, training and classification or outcome postsurgery, including RTP, could be determined.…”

Section: Discussionmentioning

confidence: 99%

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

Latham

Goodwin

Stirling³

et al. 2017

BMJ Open Sport Exerc Med

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“…According to the West Point Ankle Grading System, three grades of syndesmotic injuries can be distinguished 1. A grade I injury involves a partial tear to the anterior inferior tibiofibular ligament (AITFL) with a normal ankle radiograph.…”

Section: Introductionmentioning

confidence: 99%

Determining the force required in arthroscopic evaluation to assess the stability of syndesmotic ankle injury: a cadaveric study

et al. 2019

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IntroductionThe diagnosis of isolated distal tibiofibular syndesmotic ankle instability proves to be a challenge. Although diagnostic imaging has added value, it is limited in the detection of distal syndesmotic ankle instability. The gold standard remains intraoperative testing through arthroscopic probing while externally stressing the ankle in a sagittal direction. However, no validated arthroscopic guidelines have been established to distinguish a stable from an unstable syndesmotic ankle joint. This cadaveric study presents anatomical and biomechanical data that can help surgeons correctly identify isolated distal syndesmotic ankle instability.ObjectiveThe purpose of this study is to quantify the necessary forces applied during ankle arthroscopy to evaluate syndesmotic instability in freshly frozen cadaveric ankles.MethodsA total of 16 fresh frozen cadaveric (age 58–74 years) ankles were included in the study. A dynamometer was used to measure the force necessary for the shaver tip to be inserted into the distal tibiofibular joint with the ankle in a neutral position. Measurements were performed first with the syndesmosis intact, and again following progressive transection of the syndesmotic ligaments, along with distal fixation.ResultsSignificant differences were noted in the mean force required between the anterior inferior tibiofibular ligament (AITFL)+interosseous ligament (IOL) and no ligament cut methods (p<0.001 between the AITFL+IOL and AITFL cut (p<0.001; 95% CI 44.80 to 50.70), and between the AITFL+IOL and AITFL+IOL+ PITFL cut (p<0.001). There were also significant differences in the necessary mean forces applied between the one-SB and two-SB methods (p<0.001), between the one-SB and one-screw methods (p=0.010), between the one-SB and two-screw methods (p=0.01), between the two-SB and two-screw methods (p=0.003) and between the one-screw and two-screw methods (p<0.001). Significant differences were found between the AITFL+IOL cut and the one-SB (p<0.001), the two-SB (p<0.001), the one-screw (p<0.001) and the two-screw (p<0.001) methods.ConclusionsThis cadaveric study provides biomechanical data that can assist the surgeon in the arthroscopic evaluation of syndesmotic injuries. The data from this study need to be clinically correlated to ultimately assist in improving the outcome of patients with syndesmotic ankle injuries. Our study offers to bridge the gap to the development of arthroscopic tools that can identify the need for surgical fixation to the syndesmosis based on the laxity of specific ankle ligaments that contribute to subtle instability.Level of evidenceLevel V cadaveric study.

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“…Sprain Grade System (2,(7)(8)(9) , que establece 3 grados de inestabilidad tibiofibular basándose en hallazgos clínicos y de radiografía simple (Tabla 1); sin embargo, no queda clara la diferencia entre los grados I y II, lo que puede dar lugar a dudas en la práctica clínica (9) . La European Society of Sports Traumatology, Knee Surgery and Arthroscopy-Ankle and Foot Associates (ESSKA-AFAS), tras una revisión de la bibliografía, define la lesión aislada de la sindesmosis tibiofibular distal como la lesión de uno o más ligamentos de la sindesmosis, asociada o no a afectación del complejo ligamentoso deltoideo, y la clasifica en función del tiempo de evolución como aguda, cuando presenta menos de 6 semanas, subaguda entre 6 semanas y 6 meses, y crónica con una evolución de más de 6 meses, siendo estos plazos determinantes a la hora de establecer el tratamiento más adecuado en cada caso (9) .…”

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Iglesias-Durán¹,

Abarquero-Diezhandino²

2019

MACT

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Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines

Abstract: IV.

Cited by 111 publications

References 62 publications

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

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

Determining the force required in arthroscopic evaluation to assess the stability of syndesmotic ankle injury: a cadaveric study

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