Five-Year Outcomes After Treatment for Acute Instability of the Tibiofibular Syndesmosis Using a Suture-Button Fixation System

Abstract

Background:Suture-button repair is a widely accepted surgical treatment for acute and isolated ankle syndesmosis injuries. To our knowledge, midterm results have not previously been reported.Purpose:To evaluate the clinical, qualitative, and quantitative radiological midterm outcomes of suture-button repair after acute isolated ankle syndesmosis injuries.Study Design:Retrospective case series; Level of evidence, 4.Methods:Clinical outcomes were measured using the Foot and Ankle Disability Index (FADI) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Three-tesla magnetic resonance imaging (MRI) was performed bilaterally at the ankle. Besides morphological sequences for evaluation of the syndesmosis and degenerative changes of the ankle using the Ankle Osteoarthritis Scoring System (AOSS), the MR protocol included a coronal 2-dimensional multislice multiecho sequence for quantitative cartilage T2-weighted mapping. Spearman correlations and paired t tests were used for statistical analysis.Results:This retrospective study included 19 consecutive patients (mean age, 29.7 ± 11.5 years) with acute isolated syndesmosis injuries treated with a suture-button system between January 2006 and June 2014, with a mean follow-up of 5.1 ± 2.6 years. Postoperatively, the median FADI score was 136 (range, 78-136), and the median AOFAS score was 100 (range, 87-100). Seventeen (89.5%) patients reported to have reached their preinjury level of sports activities. MRIs of 16 patients were obtained and all showed intact anterior and posterior syndesmotic ligaments; however, in most patients, the previously injured syndesmotic ligament was thickened compared with the uninjured ankle. Average width of the anterior (P = .81) and posterior (P = .60) syndesmosis was not significantly different between the ipsilateral (3.2 ± 1.2 and 4.4 ± 0.9 mm) and contralateral ankles (3.0 ± 0.6 and 4.2 ± 0.7 mm). The median AOSS score was 1.5 (range, 0-11) for the ipsilateral ankle and 0 (range, 0-6) for the contralateral ankle. T2 values of articular cartilage did not significantly differ between the involved and the uninjured ankle (P = .68). Five patients needed hardware removal due to persistent skin irritation, and 1 patient suffered from reinstability of the ankle resulting in revision surgery 2 years after the index surgery.Conclusion:Suture-button fixation is an excellent treatment for acute and isolated syndesmosis injuries, resulting in stable ankles without early or advanced osteoarthritic changes at midterm follow-up.

Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study

“…When compared with time loss to play with lateral ankle sprains, numerous authors report a significantly greater time loss to play with high ankle sprains 12 13 15–17. In professional football players this results in a higher inability to train (11.7 vs 3.5 training sessions) and play official matches (1.4 vs 0.3 matches) compared with those with simple lateral ankle sprains only 16.…”

Epidemiology and return to play following isolated syndesmotic injuries of the ankle: a prospective cohort study of 3677 male professional footballers in the UEFA Elite Club Injury Study

“…Hence, the time to return to play after injury over the past 15 seasons has decreased. A reason for this decrease could be that recent research on treatment strategies and diagnosing the severity of the injury may have lead to improved outcomes 11 23 32–34. Nevertheless, to reduce the risk and consequences of this injury to a team, club medical staff should be conscious of whether the injury is stable or unstable since each requires different treatment strategies 11.…”

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

“…2,5,17,18 Despite permitting a flexible syndesmosis, suture button constructs have been shown insufficient for returning joint contact stresses to intact patterns. 16 Though patient-reported outcomes with flexible syndesmotic repairs are nearly always equivalent or superior to those reported for screw fixation, even after screw removal, 7,[13][14][15]34 these improved outcomes appear to be in spite of persistent abnormal ankle biomechanics.…”

“…Potentially negative consequences of rigid syndesmotic fixation have prompted the use of more flexible syndesmotic repair techniques such as K-wires, suture loops, 8 or suture button devices. A flexible repair approach can more closely mimic the function of the syndesmosis, 10 allowing movement of the fibula relative to the tibia, which often (but not always) 7,12,27 eliminates the need for a follow-up surgery to remove the fixation device. While rare, complications such as bone tunnel erosion and infection have been associated with commercially available flexible syndesmotic fixation devices.…”