Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies

Abstract

Purpose Although simultaneous arthroscopy for the surgical treatment of acute isolated, unstable syndesmotic injuries has been recommended, little knowledge is present about the actual frequency of intra-articular pathologies for this injury. The aim of this study was to investigate the frequency and severity of intra-articular pathologies detected during arthroscopy and their subsequent treatment in acute isolated, unstable syndesmotic injuries. Methods A retrospective chart review of patients treated by arthroscopic-assisted stabilization for acute isolated, syndesmotic instability was performed. The primary outcome parameter was the frequency of intra-articular pathologies. Secondary outcome parameters were the type of syndesmotic lesion (ligamentous/bony), severity of chondral lesions, MRI findings, treatment details, complications and the identification of factors associated with intra-articular pathologies. Results Twenty-seven patients, 19% female, with a mean age of 37 ± 12 years met the inclusion criteria. 70% suffered isolated ligamentous injuries, the remaining suffered avulsion fractures of the syndesmosis. Chondral lesions occurred in 48% (ICRS grade II: 33%; ICRS grade IV 15%) and intra-articular loose bodies in 11% of patients. Overall, arthroscopy revealed intra-articular pathologies necessitating further treatment in 19% of patients. Neither the type of syndesmotic injury (bony vs. ligamentous; ns) nor the degree of ligamentous instability (West Point IIB vs. III; ns) had a significant influence on the occurrence of chondral lesions. One complication (SSI) occurred. Pre-operative MRI revealed a sensitivity/specificity of 100/79% for chondral lesions and 50/93% for loose bodies. Conclusion Intra-articular pathologies in acute isolated, unstable syndesmotic injuries occur in up to 50% of patients, 19% necessitated additional treatment. Simultaneous arthroscopy, independent of the pre-operative MRI findings, appears reasonable in highly active patients. Level of evidence Level III.

The ankle cartilage cascade: incremental cartilage damage in the ankle joint

“…As concluded by Mankin et al in 1974, if superficial lacerations of articular cartilage are limited in size and depth, they will ‘ neither heal nor progress to more serious disorders ’ [ 16 , 17 ]. This statement can be substantiated by a recent meta-analysis that showed that although the incidence of reported osteochondral damage after ankle sprain or fracture was high (namely 45%), the proportion that may result in poor clinical outcomes (as a consequence of osteochondral damage or end-stage osteoarthritis) can be considered relatively low [ 5 , 19 , 26 , 33 , 37 ]. This finding has further been described by several studies reporting good patient-reported mid- to long-term outcomes following ankle trauma (sprains and fractures) [ 11 , 12 ].…”

Incidence of (Osteo)Chondral Lesions of the Ankle in Isolated Syndesmotic Injuries: A Systematic Review and Meta-Analysis

“…There were 63 talar lesions (95.4%) and 3 tibial lesions (4.5%). One study 5 reported on a specified sub-localization distribution of the lesions, and these results can be appreciated in Table 3 . Lesion size was not reported in any of the studies.…”

“…The overall pooled incidence rate of (osteo)chondral lesions in the ankle joint in all isolated syndesmotic injuries—acute and chronic group combined—was 20.7% (95% CI: 13.7%-29.9%) as there were 79 reported lesions in a total of 402 patients ( I 2 = 65%) 4 , 5 , 21 - 27 ( Fig. 2 ).…”

“…After screening the articles on title and abstract, and full-text screening, 9 articles were included – there was full agreement between the two independent authors on title, abstract, and full-text screening. 4 , 5 , 21 - 27 …”

Ankle and syndesmosis instability: consensus and controversies

“…Passage of a 3 mm spherical probe during external rotation indicates very high likelihood of rupture of both the AITFL and the IOL, 48 against previous reports classifying unstable lesions when diastasis was greater than 2 mm. Additionally, half of these lesions can present with concomitant intra-articular pathologies (osteochondral lesions, other ligamentous rupture or loose bodies) with 19% needing additional treatment, 49 reinforcing the role of arthroscopy not only for diagnosis but also for concomitant treatment. It is also an excellent tool to evaluate anatomic reduction and residual diastasis.…”