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

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Sports Medicine
Published in: Sports Medicine 2/2014

01-02-2014 | Review Article

Evaluation and Treatment Recommendations for Acute Injuries to the Ankle Syndesmosis Without Associated Fracture

Authors: Timothy L. Miller, Timothy Skalak

Published in: Sports Medicine | Issue 2/2014

Login to get access

Abstract

Ankle ligamentous injuries are commonly seen in athletes in a variety of sports. Surveys of physicians and trainers of professional sports teams have identified syndesmotic injuries as among the most difficult to treat. In particular, injuries of the ankle syndesmosis have been strongly linked with a prolonged recovery and increased time to return to play. Due to sudden external rotation with the tibiotalar joint in dorsiflexion, these structures are commonly injured in association with fractures of the distal fibula. Surgery is indicated in cases with associated fractures and ligamentous instability, but optimal treatment for syndesmosis injuries without an associated fracture is less clear. A thorough history and physical examination, as well as appropriate imaging, are necessary to effectively diagnose and classify the injury. For stable injuries, short-term immobilization and functional rehabilitation is recommended. Unstable Grade 2 and 3 injuries require surgical fixation. Debate currently exists over rigid screw fixation versus suture button techniques as the ideal fixation method.
Literature
1.
van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456–63.PubMedCrossRef
2.
Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in national hockey league players. Am J Sports Med. 2004;32(8):1941–5.PubMedCrossRef
3.
Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. 1989;17(2):282–5 (discussion 5–6).
4.
Porter DA. Evaluation and treatment of ankle syndesmosis injuries. Instr Course Lect. 2009;58:575–81.PubMed
5.
Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15(6):330–9.PubMed
6.
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653–60.PubMedCrossRef
7.
8.
Moseley JB, Chimenti BT. Foot and ankle injuries in the professional athlete. In: Baxter DE, editor. The foot and ankle in sport. New York: Mosby; 1995. p. 321–8.
9.
Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006;36(6):372–84.PubMedCrossRef
10.
11.
Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10(6):325–30.PubMedCrossRef
12.
Taylor DC, Englehardt DL, Bassett FH 3rd. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med. 1992;20(2):146–50.PubMedCrossRef
13.
Porter DA. Ligamentous injuries of the foot and ankle. In: Fitzgerald RH, Kaufer H, Malkani AL, editors. Orthopaedics. St. Louis: Mosby; 2002.
14.
15.
Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33(5):371–8.PubMedCrossRef
16.
Lauge-Hansen N. Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction. AMA Arch Surg. 1952;64(4):488–500.PubMedCrossRef
17.
Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge–Hansen classification of ankle injuries. Radiographics. 2012;32(2):E71–84.PubMedCrossRef
18.
Lauge-Hansen N. Fractures of the ankle. III. Genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Rad Ther Nucl Med. 1954;71(3):456–71.
19.
Fites B, Kunes J, Madaleno J, Silvestri P, Johnson DL. Latent syndesmosis injuries in athletes. Orthopedics. 2006;29(2):124–7.PubMed
20.
Clanton TO. Ankle sprains, ankle instability and syndesmosis injuries. In: Porter DA, Schon LC, editors. Baxter’s the foot and ankle in sport. 2nd ed. Philadelphia: Mosby; 2009. p. 273–390.
21.
Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. 2012;6(6):6.
22.
Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10(3):156–60.PubMedCrossRef
23.
Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18(11):693–8.PubMedCrossRef
24.
Beumer A, Campo MM, Niesing R, Day J, Kleinrensink GJ, Swierstra BA. Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury. 2005;36(1):60–4.PubMedCrossRef
25.
Gill JB, Risko T, Raducan V, Grimes JS, Schutt RC Jr. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am. 2007;89(5):994–9.PubMedCrossRef
26.
Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012;4(1):e5.CrossRef
27.
Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011;50(6):762–5.PubMedCrossRef
28.
McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc. 2012;7(7):7.
29.
Amendola A, Williams G, Foster D. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains. Sports Med Arthrosc. 2006;14(4):232–6.PubMedCrossRef
30.
Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431(431):207–12.PubMedCrossRef
31.
32.
Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int. 2009;30(5):419–26.PubMedCrossRef
33.
Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012;26(7):439–43.PubMedCrossRef
34.
Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828–35.PubMedCrossRef
35.
Cottom JM, Hyer CF, Philbin TM, Berlet GC. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620–30.PubMedCrossRef
36.
Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250–6.PubMedCrossRef
37.
Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69–75.PubMedCrossRef
38.
Massobrio M, Antonietti G, Albanese P, Necci F. Operative treatment of tibiofibular diastasis: a comparative study between transfixation screw and reabsorbable cerclage. Preliminary result. Clin Ther. 2011;162(6):e161–7.
39.
Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36(6):1199–206.PubMedCentralPubMedCrossRef
40.
Teramoto A, Suzuki D, Kamiya T, Chikenji T, Watanabe K, Yamashita T. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med. 2011;39(10):2226–32.PubMedCrossRef
41.
Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007;35(11):1833–8.PubMedCrossRef
42.
Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35(7):1197–207.PubMedCrossRef
43.
Press CM, Gupta A, Hutchinson MR. Management of ankle syndesmosis injuries in the athlete. Curr Sports Med Rep. 2009;8(5):228–33.PubMedCrossRef
44.
45.
Carr J. Malleolar fractures and soft tissue injuries of the ankle. In: Browner B, Jupiter J, Levine A, Trafton PG, editors. Skeletal trauma: fractures, dislocations, ligamentous injuries. Philadelphia: Saunders; 2003. p. 2307–74.
Metadata
Title
Evaluation and Treatment Recommendations for Acute Injuries to the Ankle Syndesmosis Without Associated Fracture
Authors
Timothy L. Miller
Timothy Skalak
Publication date
01-02-2014
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 2/2014
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-013-0106-1

Other articles of this Issue 2/2014

Sports Medicine 2/2014 Go to the issue

Systematic Review

Sprint Interval Training Effects on Aerobic Capacity: A Systematic Review and Meta-Analysis

Review Article

Differential Effects of Aerobic Exercise, Resistance Training and Combined Exercise Modalities on Cholesterol and the Lipid Profile: Review, Synthesis and Recommendations

Systematic Review

Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review

Review Article

Application of Decision-Making Theory to the Regulation of Muscular Work Rate during Self-Paced Competitive Endurance Activity

Review Article

The Health Effects of Exercising in Air Pollution

Review Article

Role of the Mirror-Neuron System in Cross-Education