Dynamically Unstable Syndesmosis Injuries

Metzler, Adam V.; Johnson, Darren L.

doi:10.3928/01477447-20130222-07

Orthopedics

2013

DOI: 10.3928/01477447-20130222-07

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Dynamically Unstable Syndesmosis Injuries

Adam V. Metzler

Darren L. Johnson

Abstract: Distal tibiofibular syndesmosis injuries are complex injuries that often result in extended loss of playing time for athletes. Unstable syndesmosis injuries are uniformly reduced and stabilized by numerous methods. Controversy arises from syndesmosis injuries that are stable on stress radiographs but functionally unstable with loading of the ankle during athletic activity. The authors present a case of operative fixation of a dynamically unstable syndesmosis and detail the postoperative course.

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“… 8 , 27 Isolated disruption of the ligaments of the syndesmosis, the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM), occurs in 1% to 74% of ankle injuries. 15 Syndesmotic injuries have been shown to be predictive of residual symptoms after an ankle sprain, requiring nearly twice the recovery time of isolated grade III lateral ankle sprains. 5 , 6 …”

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Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

Patel

Chan

Murphy

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Disruption of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM) is a predictive measure of residual symptoms after an ankle injury. Controversy remains regarding the ideal fixation technique for early return to sport, which requires restoration of tibiofibular kinematics with early weightbearing. Purpose: To quantify tibiofibular kinematics after syndesmotic fixation with different tricortical screw and suture button constructs during simulated weightbearing. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic testing system was used to test 9 fresh-frozen human cadaveric specimens (mean age, 65.1 ± 17.3 years). A 200-N compressive load was applied to the ankle, while a 5-N·m external rotation and a 5-N·m inversion moment were applied independently to the ankle at 0° of flexion, 15° and 30° of plantarflexion, and 10° of dorsiflexion. Fibular medial-lateral translation, anterior-posterior translation, and internal-external rotation relative to the tibia were tracked by use of an optical tracking system in the following states: (1) intact ankle; (2) AITFL, PITFL, and IOM transected ankle; (3) single-screw fixation; (4) double-screw fixation; (5) hybrid fixation; (6) single suture button fixation; and (7) divergent suture button fixation. Repeated-measures analysis of variance with Bonferroni correction was performed for statistical analysis. Results: In response to the external rotation moment and axial compression, single tricortical screw fixation resulted in significantly higher lateral translation of the fibula compared with that of the intact ankle at 10° of dorsiflexion ( P < .05). Suture button fixation resulted in significantly higher posterior translation of the fibula at 0° of flexion and 10° of dorsiflexion, whereas divergent suture button fixation resulted in higher posterior translation at only 0° of flexion ( P < .05). In response to the inversion moment and axial compression, single tricortical screw and hybrid fixation significantly decreased lateral translation in plantarflexion, whereas double tricortical screw fixation and hybrid fixation significantly decreased external rotation of the fibula compared with that of the intact ankle at 15° of plantarflexion ( P < .05). Conclusion: Based on the data in this study, hybrid fixation with 1 suture button and 1 tricortical screw may most appropriately restore tibiofibular kinematics for early weightbearing. However, overconstraint of motion during inversion may occur, which has unknown clinical significance. Clinical Relevance: Surgeons may consider this data when deciding on the best algorithm for syndesmosis repair and postoperative rehabilitation.

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confidence: 99%

Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

Patel

Chan

Murphy

et al. 2020

Orthopaedic Journal of Sports Medicine

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Dynamically Unstable Syndesmosis Injuries

Cited by 1 publication

References 13 publications

Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

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