Correlating MRI Findings with Disability in Syndesmotic Sprains of NFL Players

Sikka, Robby; Fetzer, Gary B.; Sugarman, Eric; Wright, Rick W.; Fritts, Hollis M.; Boyd, Joel L.; Fischer, David A.

doi:10.3113/fai.2012.0371

Cited by 65 publications

(57 citation statements)

References 21 publications

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“…MRI has excellent sensitivity and specificity for ASI14 and is far less invasive than arthroscopy, which is considered the reference standard 15. We used a classification system for ASI described by Sikka et al ,16 which is applicable to our conservatively managed cohort. The grade is based on those ligamentous structures involved, as seen on MRI, that are thought to be injured sequentially with increasing tibiofibular displacement caused by increasing degrees of talar external rotation 17.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

Samra

Sman

Rae

et al. 2015

BMJ Open Sport Exerc Med

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AimsTo determine whether a single ultrasound-guided platelet-rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match play following MRI confirmed ankle syndesmosis injury.MethodsCohort controlled pilot study. 10 Rugby Union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 days of MRI confirmed ankle syndesmosis injury. A historical control group included 11 comparable Rugby Union players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 weeks after the removal of the CAM (controlled ankle motion) boot. Time to return to play was recorded. Repeat functional testing occurred within 1 week of return to play.ResultsGroups were comparable in anthropometrics, playing position and MRI injury severity. Time to return to play was significantly less in the intervention group (p=0.048). Following return to play, athletes in the intervention group showed higher agility (p=0.002) and vertical jump (p=0.001). There was a lower level of fear avoidance associated with rugby in the intervention group (p=0.014).ConclusionsThis pilot study shows that, following ankle syndesmosis injury, a single autologous PRP injection may accelerate safe and successful return to Rugby Union, with improved functional capacity and reduced fear avoidance. It demonstrates the feasibility of a randomised controlled trial to further assess this therapy.Trial registration numberANZCTRN12614000055606.

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Section: Methodsmentioning

confidence: 99%

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

Samra

Sman

Rae

et al. 2015

BMJ Open Sport Exerc Med

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“…25 More severe injuries, as determined by MRI involvement of the IOL and PITFL, were positively correlated with increased numbers of missed games and practices. 71 The number of missed competitions also correlated with the interosseous tenderness length 30 and a squeeze test with positive results. 30,71 Although syndesmotic injury is most predictive of persistent symptoms in the athletic population, 95 with correct diagnosis, function is typically good after the initial recovery period.…”

Section: Conservative Treatmentmentioning

confidence: 95%

“…MRI can be used to grade the injury and may be useful in predicting the time of disability, with involvement of the PITFL possibly signifying a more severe injury. 71 Although MRI is sensitive and specific for syndesmotic injuries using standard protocol at 3.0 T, 68 it is not predictive for instability because it is a static test. 49 In addition, injury to the tibiofibular syndesmosis has a significant association with several secondary findings on MRI, including anterior talofibular ligament injury and osteochondral lesions.…”

Section: Initial Radiographic Evaluationmentioning

confidence: 99%

Acute and Chronic Injuries to the Syndesmosis

Switaj

Mendoza

Kadakia

2015

Clinics in Sports Medicine

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“…Average age at the time of injury was 22 years (SD 3.3, range [17][18][19][20][21][22][23][24][25][26][27][28]. Players had no current or past medical report of note and their main complaint was pain, instability and reduced ability to weight bear in the affected ankle.…”

Section: Patient Informationmentioning

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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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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Correlating MRI Findings with Disability in Syndesmotic Sprains of NFL Players

Abstract: MRI can be useful to help delineate the injury pattern and associated injuries, and may be useful in predicting time of disability using a grading system. Positive squeeze test can also be useful to determine prognosis.

Cited by 65 publications

References 21 publications

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

Acute and Chronic Injuries to the Syndesmosis

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

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