Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device

Colcuc, Christian; Blank, Manfred; Stein, Thomas; Raimann, Florian J.; Weber-Spickschen, Sanjay; Fischer, Sebastian; Hoffmann, Reinhard

doi:10.1007/s00167-017-4820-3

Cited by 56 publications

(84 citation statements)

References 34 publications

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“…Three studies included ankle fractures with syndesmosis disruption, 4,13,14 and 2 studies included patients with acute isolated syndesmosis disruption and with ankle fracture associated with syndesmosis disruption. 1,5 Table 2 summarizes the outcomes of the included studies.…”

Section: Resultsmentioning

confidence: 99%

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials

et al. 2018

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Background: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries. Purpose: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. Study Design: Meta-analysis. Methods: A literature search was performed according to the PRISMA guidelines to identify randomized controlled trials comparing the SB and SS techniques for syndesmosis injuries. Level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Statistical analysis was performed with RevMan, and a P value ≤.05 was considered statistically significant. Results: Five clinical studies were identified, allowing comparison of 143 patients in the SB group with 142 patients in the SS group. Patients treated with the SB technique had a higher postoperative American Orthopaedic Foot & Ankle Society score at a mean 20.8 months (95.3 vs 86.7, P < .001). The SB group resulted in a lower rate of broken implants (0.0% vs 25.4%, P < .001), implant removal (6.0% vs 22.4%, P = .01), and joint malreduction (0.8% vs 11.5%, P = .05) as compared with the SS group. Conclusion: The SB technique results in improved functional outcomes as well as lower rates of broken implant and joint malreduction. Based on the findings of this meta-analysis, the SB technique warrants a grade A recommendation by comparison with the SS technique for the treatment of syndesmosis injuries.

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Section: Resultsmentioning

confidence: 99%

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials

et al. 2018

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“…As a result, late tibioperoneal diastasis can be regarded as a common finding after screw removal, as already described by other authors, 29 and recurrent diastasis or instability could occur. 1,5…”

Section: Discussionmentioning

confidence: 99%

“…The restoration of more physiologic movements of the syndesmosis obtained with dynamic devices could have contributed to faster healing and clinical recovery. 16 In fact, a shorter time to return to work and sports activity was reported in 2 studies, 5,19 even with consideration that a standardized rehabilitation protocol was used in the 2 groups (despite the possibility of early weightbearing in the case of dynamic fixation). Another theoretical advantage of dynamic fixation, especially with suture buttons, is that it may allow more motion and improved self-centering of the syndesmosis, thus making anatomic reduction easier to accomplish.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials

et al. 2019

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Background: Several devices for obtaining dynamic fixation of the syndesmosis have been introduced in recent years, but their efficacy has been tested in only a few randomized controlled trials (RCTs), without demonstrating any clear benefit over the traditional static fixation with screws. Purpose: To perform a level 1 meta-analysis of RCTs to investigate the complications, subjective outcomes, and functional results after dynamic or static fixation of acute syndesmotic injuries. Study Design: Meta-analysis of RCTs. Methods: A systematic literature search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase electronic databases, as well as ClinicalTrials.gov for unpublished studies. Eligible studies were RCTs comparing dynamic fixation and static fixation of acute syndesmosis injuries. A meta-analysis was performed, while bias and quality of evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: Dynamic fixation had a significantly reduced relative risk (RR = 0.55, P = .003) of complications—in particular, the presence of inadequate reduction at the final follow-up (RR = 0.36, P = .0008) and the clinical diagnosis of recurrent diastasis or instability (RR = 0.10, P = .03). The effect was more evident when compared with permanent screws (RR = 0.10, P = .0001). The reoperation rate was similar between the groups (RR = 0.64, P = .07); however, the overall risk was reduced after dynamic fixation as compared with static fixation with permanent screws (RR = 0.24, P = .007). The American Orthopaedic Foot & Ankle Society score was significantly higher among patients treated with dynamic fixation—6.06 points higher ( P = .005) at 3 months, 5.21 points ( P = .03) at 12 months, and 8.60 points ( P < .00001) at 24 months—while the Olerud-Molander score was similar. The visual analog scale for pain score was reduced at 6 months (–0.73 points, P = .003) and 12 months (–0.52 points, P = .005), and ankle range of motion increased by 4.36° ( P = .03) with dynamic fixation. The overall quality of evidence ranged from “moderate” to “very low,” owing to a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. Conclusion: The dynamic fixation of syndesmotic injuries was able to reduce the number of complications and improve clinical outcomes as compared with static screw fixation—especially malreduction and clinical instability or diastasis—at a follow-up of 2 years. A lower risk of reoperation was found with dynamic fixation as compared with static fixation with permanent screws. However, the lack of patients or personnel blinding, treatment heterogeneity, small samples, and short follow-up limit the overall quality of this evidence.

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“…Several fixation methods such as suture-button fixation, tightrope fixation, and syndesmotic hook fixation have been used in the treatment of distal tibiofibular syndesmosis injury, and satisfactory outcomes have been achieved using these methods. [ 25 , 32 , 33 ] Recently, suture-button techniques have been popularized for the treatment of distal tibiofibular syndesmosis injury, and several studies have reported that suture-button fixation can achieve satisfactory outcomes. [ 25 , 33 – 38 ] A recent systematic review reported that suture-button fixation is associated with a better objective range of motion, an earlier return to work, and lower rates of implant removal, implant failure, and malreduction, compared with screw fixation, though similar functional outcomes as measured by the AOFAS score and postoperative complication rates were found.…”

Section: Discussionmentioning

confidence: 99%

“…[ 25 , 32 , 33 ] Recently, suture-button techniques have been popularized for the treatment of distal tibiofibular syndesmosis injury, and several studies have reported that suture-button fixation can achieve satisfactory outcomes. [ 25 , 33 – 38 ] A recent systematic review reported that suture-button fixation is associated with a better objective range of motion, an earlier return to work, and lower rates of implant removal, implant failure, and malreduction, compared with screw fixation, though similar functional outcomes as measured by the AOFAS score and postoperative complication rates were found. [ 15 ] In addition, a meta-analysis by Gan et al has reported that dynamic fixation using suture-button fixation results in similar clinical outcomes for the treatment of distal tibiofibular syndesmosis injury compared with static fixation using screw fixation but is associated with a reduced requirement for secondary intervention.…”

Section: Discussionmentioning

confidence: 99%

Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury

Song¹,

Zhi-fu²,

Kuang³

et al. 2020

Medicine

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This study aimed to investigate the effectiveness of tendon suture fixation versus cortical screw fixation for the treatment of distal tibiofibular syndesmosis injury. This study recruited 42 patients with Danis-Weber type B, C1 and C2 fractures concomitant with lower tibiofibular syndesmosis injury, who were randomly assigned to 2 groups according to treatment with cortical screw fixation (n = 21) and tendon suture fixation (n = 21). Operation time, intraoperative blood loss, time to full weight-bearing activity, medical cost, ankle function, and ankle pain were compared between the 2 groups. The operation time was significantly less with cortical screw fixation (57.1 ± 5.3 min) than with tendon suture fixation (63.3 ± 6.3 min; p = 0.01), but there was no significant difference in intraoperative blood loss. The time until full weight-bearing was possible was significantly longer after cortical screw fixation (10.9 ± 2.7 weeks) than after tendon suture fixation (7.1 ± 1.9 weeks; P < .001). The medical cost was much greater for cortical screw fixation (1861.6 ± 187.3 USD) than for tendon suture fixation (1209.6 ± 97.6 USD; P < .01). The rate of excellent and good ankle function at 3 months after surgery was significantly higher with tendon suture fixation (71.4%) than with cortical screw fixation (33.3%; P = .03). Tendon suture fixation is associated with quicker recovery of ankle function, shorter time to full weight-bearing, and lower medical cost to the patient compared with screw fixation. Our findings suggest that tendon suture fixation is an effective method for the treatment of tibiofibular syndesmosis injury.

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Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device

Abstract: Randomized controlled trial, Level I.

Cited by 56 publications

References 34 publications

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials

Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials

Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury

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