Late reconstruction of the anterior distal tibiofibular syndesmosis: Good outcome in 9 patients

Radiographic identification of the primary structures of the ankle syndesmosis

“…Beumer et al [4] initially described a technique in which an attenuated and elongated AITFL was retensioned through a proximal and medializing osteotomy of its tibial insertion. Grass et al [14] subsequently described a modification of a peroneus longus ligamentoplasty in which a split peroneus longus tendon was threaded through a combination of three fibular and tibial canals to reconstruct the posterior, interosseous, and anterior ligaments of the syndesmosis.…”

Chronic instability of the anterior syndesmosis of the ankle

“…This number of injuries may increase to more than 40% in those involved in high contact or collision sporting activities (Gerber et al 1998). Syndesmotic injuries are often mistaken for the more common lateral ankle sprains and subsequently not treated properly (Gerber et al 1998, Boytim et al 1991, which can result in chronic syndesmotic instability (Beumer et al 2005c, Grass et al 2003, Beumer et al 2000, Bonnin 1965, Mullins and Sallis 1958. This can be avoided by proper evaluation of ankle injuries at the accident and emergency department and by instruction of general practitioners, physiotherapists, (sport) physicians and orthopaedic and trauma surgeons.…”

Clinical diagnosis of syndesmotic ankle instability

“…In clinical practice, medical history and physical examination interact to lead to the clinical diagnosis. Chronic syndesniotic injury should be suspected in cases of long-standing complaints of pain in the region of the syndesmosis, sensation of instability and recurrent swelling (Hopkinson et al 1990, OgilvieHarris and Reed 1994, Beumer et al 2000. None of the syndesmotic stress tests per se proved to have a satisfactory predictive value.…”

“…After assessing each ankle, the examiner had to make a "physical diagnosis" regarding the presence or absence of a syndesmotic injury. On the following day, the 3 patients underwent an arthroscopy of the ankle to determine the presence of a syndesmotic injury (Beumer et al 2000).…”