Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2020

01-10-2020 | Arthroscopy | ANKLE

Delayed stabilisation of dynamically unstable syndesmotic injuries results in worse functional outcomes

Authors: Steven Kent, Gerald Yeo, Daniel Marsland, Matthew Randell, Benjamin Forster, Michael Lutz, Satomi Okano

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2020

Login to get access

Abstract

Purpose

Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function.

Method

A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010–2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury (< 6 weeks), sub-acute (6 weeks–6 months) and chronic syndesmotic injury (> 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS).

Results

Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p < 0.001), with the greatest difference in quality of life (− 20.7, 95% CI − 31.6 to − 9.8, p = 0.012). There was a mean follow-up of 4.3 years. Although the average FAOS subscales in those with sub-acute injuries were lower than in those with acute injuries, the difference was not statistically significant.

Conclusion

The results of this study suggest that delayed surgical stabilisation (> 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended.

Level of evidence

Level III.
Appendix
Available only for authorised users
Literature
1.
Abdelaziz M, Hagemeijer N, Guss D, El-Hawary A, El-Mowafi H, DiGiovanni C (2019) Evaluation of syndesmosis reduction on CT scan. Foot Ankle Int 40:1087–1093CrossRef
2.
Anderson DD, Van Hofwegen C, Marsh JL, Brown TD (2011) Is elevated contact stress predictive of post-traumatic osteoarthritis for imprecisely reduced tibial plafond fractures? J Orthop Res 29:33–39CrossRef
3.
Beumer A, van Hemert WL, Niesing R, Entius CA, Ginai AZ, Mulder PG et al (2004) Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 423:227–234CrossRef
4.
Buckwalter J, Anderson D, Brown T, Tochigi Y, Martin J (2013) The roles of mechanical stresses in the pathogenesis of osteoarthritis: implications for treatment of joint injuries. Cartilage 4:286–294CrossRef
5.
Calder JD, Bamford R, Petrie A, McCollum GA (2016) Stable versus unstable grade II high ankle sprains: a prospective study predicting the need for surgical stabilization and time to return to sports. Arthroscopy 32:634–642CrossRef
6.
Chen L, Lyman S, Do H (2012) Validation of foot and ankle outcome score for hallux valgus. Foot Ankle Int 33:1145–1155CrossRef
7.
de Cesar PC, Avila EM, de Abreu MR (2011) Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot Ankle Int 32(12):1110–1114CrossRef
8.
Desai S, Peterson A, Wing K, Younger A, Crump T, Liu G, Veljkovic A, Penner M, Sutherland J (2019) Minimally important difference in the foot and ankle outcome score among patients undergoing hallux valgus surgery. Foot Ankle Int 40:694–701CrossRef
9.
10.
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19:653–660CrossRef
11.
Hunt KJ, George E, Harris AH, Dragoo JL (2013) Epidemiology of syndesmosis injuries in intercollegiate football: Incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004–2005 to 2008–2009. Clin J Sport Med 23:278–282CrossRef
12.
Hunt KJ, Goeb Y, Behn AW, Criswell B, Chou L (2015) Ankle joint contact loads and displacement with progressive syndesmotic injury. Foot Ankle Int 36:1095–1103CrossRef
13.
Krahenbuhl N, Weinberg MW, Hintermann B, Haller JM, Saltzman CL, Barg A (2019) Surgical outcome in chronic syndesmotic injury: a systematic literature review. Foot Ankle Surg 25:691–697CrossRef
14.
Lubberts B, Guss D, Vopat BG, Johnson AH, van Dijk CN, Lee H, DiGiovanni CW (2020) The arthroscopic syndesmotic assessment tool can differentiate between stable and unstable ankle syndesmoses. Knee Surg Sports Traumatol Arthrosc 28:193–201CrossRef
15.
Mani SB, Brown HC, Nair P, Chen L, Do HT, Lyman S, Deland JT, Ellis SJ (2013) Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity. Foot Ankle Int 34:1140–1146CrossRef
16.
McKinley TO, Tochigi Y, Rudert MJ, Brown TD (2008) Instability associated changes in contact stress and contact stress rates near a step-off incongruity. J Bone Jt Surg 90:375–383CrossRef
17.
Ogilvie-Harris DJ, Gilbart MK, Chorney K (1997) Chronic pain following ankle sprains in the athlete: the role of arthroscopic surgery. Arthroscopy 13:564–574CrossRef
18.
Pakarinen H, Flinkkila T, Ohtonen P, Hyvonen P, Lakovaara M, Leppilahti J et al (2011) Intraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests. J Bone Jt Surg Am 93:2057–2061CrossRef
19.
Rammelt S, Zwipp H, Grass R (2008) Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin 13:611–633CrossRef
20.
Randell M, Marsland D, Ballard E, Forster B, Lutz M (2019) MRI for high ankle sprains with an unstable syndesmosis: posterior malleolus bone oedema is common and time to scan matters. Knee Surg Sports Traumatol Arthrosc 27:2890–2897CrossRef
21.
Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794CrossRef
22.
Sman AD, Hiller CE, Rae K, Linklater J, Black D, Nicholson L et al (2015) Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med 49:323–329CrossRef
23.
Sman AD, Hiller CE, Refshauge KM (2013) Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med 47:620–628CrossRef
24.
Takao M, Ochi M, Oae K, Naito K, Uchio Y (2003) Diagnosis of a tear of the tibiofibular syndesmosis: the role of arthroscopy of the ankle. J Bone Jt Surg Br 85:324–329CrossRef
25.
Turky M, Menon KV, Saeed K (2018) Arthroscopic grading of injuries of the inferior tibiofibular syndesmosis. J Foot Ankle Surg 57:1125–1129CrossRef
26.
Tochigi Y, Rudert MJ, McKinley TO, Pedersen DR, Brown TD (2008) Correlation of dynamic cartilage contact stress aberrations with severity of instability in ankle incongruity. J Orthop Res 26:1186–1193CrossRef
27.
van Dijk C, Longo G, Loppini M, Florio P, Maltese L, Ciuffreda M et al (2016) Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 24:1200–1216CrossRef
28.
VanVlijmen N, Denk K, vanKampen A, RuurdL J (2015) Long-term results after ankle syndesmosis injuries. Orthopedics 38:1001–1006CrossRef
29.
Waterman BR, Belmont PJ Jr, Cameron KL, Svoboda SJ, Alitz CJ, Owens BD (2011) Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med 39:992–998CrossRef
30.
Wright RW, Barlie J, Surprenant DA, Matava MJ (2004) Ankle syndesmosis sprains in national hockey league players. Am J Sports Med 32:1941–1945CrossRef
Metadata
Title
Delayed stabilisation of dynamically unstable syndesmotic injuries results in worse functional outcomes
Authors
Steven Kent
Gerald Yeo
Daniel Marsland
Matthew Randell
Benjamin Forster
Michael Lutz
Satomi Okano
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05962-1

Other articles of this Issue 10/2020

Knee Surgery, Sports Traumatology, Arthroscopy 10/2020 Go to the issue

KNEE

Deviations in femoral joint lines using calipered kinematically aligned TKA from virtually planned joint lines are small and do not affect clinical outcomes

KNEE

The tibial cut influences the patellofemoral knee kinematics and pressure distribution in total knee arthroplasty with constitutional varus alignment

ANKLE

Concomitant ankle instability has a negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU)

KNEE

Anterior-stabilized TKA is inferior to posterior-stabilized TKA in terms of postoperative posterior stability and knee flexion in osteoarthritic knees: a prospective randomized controlled trial with bilateral TKA

KNEE

Voluntary femoro-tibial subluxations: a benign differential diagnosis in the snapping knee of a child

KNEE

Anatomical reconstruction produced similarly favorable outcomes as repair procedures for the treatment of chronic lateral ankle instability at long-term follow-up