Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

Abstract

BackgroundThe arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively.MethodsIn 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up.ResultsThe syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively.ConclusionsTo confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

Concomitant Syndesmotic Instability and Medial Ankle Instability Are Risk Factors for Unsatisfactory Outcomes in Patients With Chronic Ankle Instability

“…However, 45% of our patients with chronic syndesmotic injury had unsatisfactory outcomes after syndesmotic reconstruction. This lower rate of satisfactory outcomes after syndesmotic reconstruction is to be expected because we set a 4-mm diastasis as our indication for fixation whereas the indication was set at a 2-mm diastasis in other reported studies 22,30 ; thus our syndesmotic fixation group had more severe injuries. Several reports have described satisfactory outcomes after anatomic reconstruction of chronic syndesmotic instability.…”

Incidence, ultrasound evaluation and outcome of syndesmotic injuries in patients with ankle sprain

“…These injuries are difficult to diagnose without the presence of fracture or frank diastasis and the diagnosis is frequently missed. As compared to lateral ankle sprain, these patients have rapid resolution of ecchymosis and edema and patients starts walking early stressing the injured ligament which leads to chronic pain and instability [11] . As there are no obvious symptoms and normal radiography, these injuries are generally missed.…”

Akut ve kronik sindesmoz yaralanmaları

“…'nın yaptıkları ileriye dönük çalışmada, AİTFL'yi yapışma yerinden 1×1 cm'lik kemik blok ile kaldırılmış; tibiada orijinal yapış-ma yerinin mediyal ve proksimalinde bir boşluk oluş-turup mortise klemp yardımı ile maksimum kompresyon uyguladıktan sonra, kemik blok bu yeni hazırlanan yuvaya yerleştirip vida ile sabitlenmiştir. [99] Takiplerde, AOFAS skorlarında anlamlı artış saptanmıştır. …”