3D Model Analysis of Ankle Flexion on Anatomic Reduction of a Syndesmotic Injury

Schon, Jason M.; Mikula, Jacob D.; Backus, Jonathon D.; Venderley, Melanie B.; Dornan, Grant J.; LaPrade, Robert F.; Clanton, Thomas O.

doi:10.1177/1071100716681605

Cited by 21 publications

(18 citation statements)

References 26 publications

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“…It was clearly stated in the discussion on limitations that future studies are needed to investigate the quantitative and qualitative effects of ankle dorsiflexion on Achilles tendon tension and resultant syndesmotic reduction. There is conflicting literature, and conflicting opinion about the appropriate flexion angle for syndesmosis fixation, as summarized nicely in an article by Schon et al 3 We completely agree with the statement that it would be very interesting to determine what effect ankle flexion has on syndesmotic reduction, and based on our results we would suggest that inclusion of Achilles and other muscle forces would be important in those investigations.…”

Section: Dear Editorsupporting

confidence: 69%

Response to “Letter Regarding: Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping”

Goetz¹,

Phistikul²

2019

Foot Ankle Int.

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Section: Dear Editorsupporting

confidence: 69%

Response to “Letter Regarding: Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping”

Goetz¹,

Phistikul²

2019

Foot Ankle Int.

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“…Imaging studies have shown that single-screw as well as single suture button and divergent suture button fixation all cause a significant volumetric reduction or overcompression of the syndesmosis, suggesting that overconstraint may occur regardless of the fixation technique used. 19,20 A previous biomechanical study demonstrated that syndesmotic injuries can cause inversion instability, and the investigators recommended using additional taping when patients initially return to sports in order to prevent inversion forces. 23 Thus, it might be clinically acceptable to slightly overconstrain tibiofibular motion in response to an inversion torque in plantarflexion in order to protect the anterior talofibular ligament, which is typically injured by this mechanism.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

Patel

Chan

Murphy

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Disruption of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM) is a predictive measure of residual symptoms after an ankle injury. Controversy remains regarding the ideal fixation technique for early return to sport, which requires restoration of tibiofibular kinematics with early weightbearing. Purpose: To quantify tibiofibular kinematics after syndesmotic fixation with different tricortical screw and suture button constructs during simulated weightbearing. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic testing system was used to test 9 fresh-frozen human cadaveric specimens (mean age, 65.1 ± 17.3 years). A 200-N compressive load was applied to the ankle, while a 5-N·m external rotation and a 5-N·m inversion moment were applied independently to the ankle at 0° of flexion, 15° and 30° of plantarflexion, and 10° of dorsiflexion. Fibular medial-lateral translation, anterior-posterior translation, and internal-external rotation relative to the tibia were tracked by use of an optical tracking system in the following states: (1) intact ankle; (2) AITFL, PITFL, and IOM transected ankle; (3) single-screw fixation; (4) double-screw fixation; (5) hybrid fixation; (6) single suture button fixation; and (7) divergent suture button fixation. Repeated-measures analysis of variance with Bonferroni correction was performed for statistical analysis. Results: In response to the external rotation moment and axial compression, single tricortical screw fixation resulted in significantly higher lateral translation of the fibula compared with that of the intact ankle at 10° of dorsiflexion ( P < .05). Suture button fixation resulted in significantly higher posterior translation of the fibula at 0° of flexion and 10° of dorsiflexion, whereas divergent suture button fixation resulted in higher posterior translation at only 0° of flexion ( P < .05). In response to the inversion moment and axial compression, single tricortical screw and hybrid fixation significantly decreased lateral translation in plantarflexion, whereas double tricortical screw fixation and hybrid fixation significantly decreased external rotation of the fibula compared with that of the intact ankle at 15° of plantarflexion ( P < .05). Conclusion: Based on the data in this study, hybrid fixation with 1 suture button and 1 tricortical screw may most appropriately restore tibiofibular kinematics for early weightbearing. However, overconstraint of motion during inversion may occur, which has unknown clinical significance. Clinical Relevance: Surgeons may consider this data when deciding on the best algorithm for syndesmosis repair and postoperative rehabilitation.

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“…A recent cadaveric study showed that the SB and SS procedures may overcompress the syndesmosis, particularly with 2 SBs. 26,27 Therefore, regardless of the procedure used, overcompression either by inadvertent pelvic reduction clamp compression or by the fixation method utilized is possible and demands heightened awareness at the time of reduction.…”

Section: Discussionmentioning

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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3D Model Analysis of Ankle Flexion on Anatomic Reduction of a Syndesmotic Injury

Abstract: Ankle position at the time of syndesmotic fixation did not affect overall ankle ROM when using a suture-button construct; however, overcompression was observed in all positions. The clinical impact of syndesmotic overcompression remains largely unknown.

Cited by 21 publications

References 26 publications

Response to “Letter Regarding: Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping”

Response to “Letter Regarding: Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping”

Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing After Syndesmotic Injury

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

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