Ankle and syndesmosis instability: consensus and controversies

Abstract

Ankle sprains are mainly benign lesions, but if not well addressed can evolve into permanent disability. A non-treated lateral, syndesmotic or medial ankle instability can evolve into ankle osteoarthritis. For this reason, diagnosis and treatment of these entities is of extreme importance. In general, acute instabilities undergo conservative treatment, while chronic instabilities are better addressed with surgical treatment. It is important to identify which acute instabilities are better treated with early surgical treatment. Syndesmosis injuries are frequently overlooked and represent a cause for persistent pain in ankle sprains. Unstable syndesmotic lesions are always managed by surgery. Non-treated deltoid ligament ruptures can evolve into a progressive valgus deformity of the hindfoot, due to its links with the spring ligament complex. This concept would give new importance to the diagnosis and treatment of acute medial ligament lesions. Multi-ligament lesions are usually unstable and are better treated with early surgery. A high suspicion rate is required, especially for combined syndesmotic and medial lesions or lateral and medial lesions. Ankle arthroscopy is a powerful tool for both diagnostic and treatment purposes. It is becoming mandatory in the management of ankle instabilities and multiple arthroscopic lateral/syndesmotic/medial repair techniques are emerging. Cite this article: EFORT Open Rev 2021;6:420-431. DOI: 10.1302/2058-5241.6.210017

Ankle syndesmotic instability assessment using a three-dimensional distance mapping algorithm: a cadaveric pilot WBCT study

“…Fibular malpositioning in subtle syndesmotic instability can be in the range of the tenth of the millimeters, making it impossible for conventional, manual, and isolated measurements to make accurate diagnosis (3,8,22) . Given this, and considering all the challenges of a reliable clinical diagnosis, this new technology can hopefully provide ground-breaking and accurate assessment of these extremely challenging and unforgiving injury (23,24) . Additional full study with larger number of cadaveric specimens as well as clinical applicability of this 3D WBCT distance mapping algorithm will follow.…”

Fibrocartilaginous Bed Injury of the Posterior Tibial Tendon Sheath

“…Complete rupture of the deltoid ligament is often accompanied by malleolar fractures and/or syndesmosis injury and is treated operatively, followed by below-knee cast immobilization 7,8 . However, incomplete rupture of the ligament without any frac-tures or syndesmotic injury can be treated conservatively 9,10 .…”

A Novel Adjustable EndoButton Fixation Assisted by 3D Printing Technology for Tibiofibular Syndesmosis Injury: A Biomechanical Study

“…The separation of the distal tibiofibular syndesmosis is a common orthopaedic injury that is usually associated with 1–20% of all ankle sprains and 13% of ankle fractures in patients ( Egol et al, 2010 ; Liu et al, 2018 ; Shimozono et al, 2019 ; Corte-Real and Caetano, 2021 ). Inappropriate treatment of syndesmosis injuries could result in ankle instability, stiffness, and poor functional performance and ultimately lead to traumatic osteoarthritis ( Krähenbühl et al, 2019 ).…”