Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials

Abstract

Background: Our aim was to compare the outcome between suture button (SB) stabilization and syndesmotic screw fixation (SF) in patients with acute syndesmotic diastasis. Methods: A systematic literature search up to June 30, 2021, was performed to identify randomized controlled trials (RCTs) comparing outcomes of SB with SF techniques in patients with acute syndesmotic diastasis. We calculated mean differences for continuous outcomes, using the Hartung-Knapp-Sidik-Jonkman method, and odds ratio for dichotomous outcomes, using the Mantel-Haenszel method. Results: Eight RCTs involving 569 patients met the inclusion criteria, 1 RCT with level I evidence, and 7 RCTs with level II evidence. The meta-analysis showed that the SB technique had a higher AOFAS score <6 months and 12 months postoperatively (MD = 4.74, 95% CI 1.68-7.80, P = .01; and MD = 5.42, 95% CI 1.50-9.33, P = .02) and reduced the risk of implant irritation (OR = 0.31, 95% CI 0.11-0.89, P = .03), implant failure (OR = 0.06, 95% CI 0.02-0.23, P < .01), and reoperation (OR = 0.43, 95% CI 0.22-0.83, P = .01). The 2 approaches did not differ in further functional outcomes or postoperative complications. Conclusion: Because functional outcomes showed no relevant difference between both SB and SF, the advantage of SB appears to be in the lower risk for postoperative complications. The SB technique led to fewer cases of implant irritation, implant failure, and reoperation compared with SF. Level of Evidence: Level I, meta-analysis of RCTs.

Effectiveness of suture button fixation versus screw fixation for the management of acute distal tibiofibular syndesmotic injuries: a systematic review protocol

“…A search of PROSPERO identified only 1 registered review on the topic in the last 2 years, which has subsequently been published by Ramadanov et al 21 This paper has significant methodological flaws, as it only searched PubMed and Google Scholar. The presence of additional papers found from an unclear and non-reproducible Google Scholar search brings into question whether the entire body of literature was included, given that only 1 database was searched.…”

“…A total of 12 systematic reviews examining clinical outcomes published between July 2017 and December 2021 was found, and these are summarized in Table 1. [14][15][16][17][18][19][20][21][22][23][24][25] Systematic reviews of biomechanical studies and cost analysis were not included. Five of the 12 reviews were limited solely to RCTs, while the remaining 7 included quasi-experimental and retrospective studies.…”

“…As a result, a systematic review is recommended to address the gaps in research outlined here and in Table 1. [14][15][16][17][18][19][20][21][22][23][24][25] The aim is primarily to include more recent research and address the generally low methodological quality of the existing reviews, which reduces confidence in the recommendations.…”

“…A preliminary search for systematic reviews was conducted in PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis on March 19, 2022. A total of 12 systematic reviews examining clinical outcomes published between July 2017 and December 2021 was found, and these are summarized in Table 1 14–25 . Systematic reviews of biomechanical studies and cost analysis were not included.…”

“…A search of PROSPERO identified only 1 registered review on the topic in the last 2 years, which has subsequently been published by Ramadanov et al 21 . This paper has significant methodological flaws, as it only searched PubMed and Google Scholar.…”