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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2016

01-04-2016 | Ankle

Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines

Authors: C. Niek van Dijk, Umile Giuseppe Longo, Mattia Loppini, Pino Florio, Ludovica Maltese, Mauro Ciuffreda, Vincenzo Denaro

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2016

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Abstract

Purpose

Correct management of syndesmotic injuries is mandatory to avoid scar tissue impingement, chronic instability, heterotopic ossification, or deformity of the ankle. The aim of the present study was to perform a systematic review of the current treatments of these injuries to identify the best non-surgical and surgical management for patients with acute isolated syndesmotic injuries.

Methods

A review of the literature was performed according to the PRISMA guidelines. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed using the following keywords: “ankle injury”, “syndesmotic injury”, “chronic”, “acute”, “treatment”, “conservative”, “non-operative” “operative”, “fixation”, “osteosynthesis”, “screw”, “synostosis”, “ligamentoplasties” over the years 1962–2015.

Results

The literature search and cross-referencing resulted in a total of 345 references, of which 283 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included four studies, describing non-surgical management, and only two studies investigating surgical management of acute isolated injuries.

Conclusions

The ESSKA-AFAS consensus panel provided recommendations to improve the management of patients with isolated acute syndesmotic injury in clinical practice. Non-surgical management is recommended for stable ankle lesions and includes: 3-week non-weight bearing, a below-the-knee cast, rest and ice, followed by proprioceptive exercises. Surgery is recommended for unstable lesions. Syndesmotic screw is recommended to achieve a temporary fixation of the mortise. Suture-button device can be considered a viable alternative to a positioning screw. Partial weight bearing is allowed 6 weeks after surgery.

Level of evidence

IV.
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Metadata
Title
Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines
Authors
C. Niek van Dijk
Umile Giuseppe Longo
Mattia Loppini
Pino Florio
Ludovica Maltese
Mauro Ciuffreda
Vincenzo Denaro
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4017-1

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