Reconstruction of Chronic Injured Distal Tibiofibular Syndesmosis with Autogenous Tendon Graft: A Systematic Review

Abstract

Background. Chronic injuries of the distal tibiofibular syndesmosis are common in patients who fail to receive adequate diagnosis and timely treatment. Reconstruction of the distal tibiofibular syndesmosis with an autogenous tendon graft in these patients is effective, although relatively rarely reported. Purpose. To investigate clinical outcomes of syndesmosis reconstruction with an autogenous tendon graft for chronic injuries of the distal tibiofibular syndesmosis by reviewing the current literature. Methods. An English literature search was conducted in the MEDLINE, CENTRAL, and Cochrane databases to identify published studies up to October 2017. Preset inclusion and exclusion criteria were applied to identify all eligible articles. Results. Five studies (all with level IV evidence) that included a total of 51 patients who underwent reconstruction with an autogenous tendon graft were identified. It was reported that the symptoms were relieved postoperatively, including obviously improved functional outcomes and restoration of motions and exercise capacity. The mean American Orthopedic Foot and Ankle Society scale score of 16 patients was 53 preoperatively and 89 postoperatively. The visual analogue scale score of 14 patients decreased from 82.4 preoperatively to 12.6 postoperatively. A total of 5 (9.8%) complication cases were reported. Conclusion. Reconstruction of the distal tibiofibular syndesmosis with an autogenous tendon for chronic syndesmosis injury showed a good therapeutic effect in terms of both subjective symptoms and objective evaluation scores. The interosseous ligament could be an appropriate reconstruction target in the treatment of chronic syndesmosis injury.

Ankle syndesmotic reconstruction in chronic ankle syndesmotic injury

“…Although they showed excellent outcomes in their series using gracilis autograft fixed with an interference screw, all six of their patients had surgery within 2 years after their first injury. Xu et al , in their systematic review, found that autograft reconstruction regains the micromotion at the joint, and most of the patients return to their work and sports 4. We believe all chronic syndesmotic injuries can be treated mainly by soft tissue reconstruction with or without a protective cortical screw 21.…”

“…Han et al , with the largest group of patients, compared the outcome of screw fixation and arthroscopic debridement versus arthroscopic debridement alone 5. They found no significant outcome between the two groups, claiming that the cause of pain is mainly due to the interposition of fibrous tissue rather than absolute mechanical instability 4. Yasui et al did a similar anatomical reconstruction of the anteroinferior tibiofibular ligament (AITFL) and arthroscopic debridement 1 20.…”

“…Moreover, there is a debate regarding diagnostic tools and treatment in previous literature. MRI has a role in diagnosis, but the arthroscopic evaluation is considered the gold standard 2 4 5…”

Simultaneous Single-Graft Tibiofibular Syndesmosis and Deltoid Ligament Reconstruction in Chronic Instability: Technical Tip

“…5 Among the available surgical options for chronic injuries, tibiofibular stabilization and arthrodesis yield improved American Orthopaedic Foot & Ankle Society (AOFAS) scores. 5,8 Arthrodesis has been recommended for lesions with significant displacement, but the subsequently limited range of motion narrows its indication to nonactive patients. 5 In contrast, anteroinferior tibiofibular (AITFL) and interosseous ligament (IOL) reconstruction techniques with autografts can yield better functional results by preserving its physiologic joint micromotion.…”

“…5 In contrast, anteroinferior tibiofibular (AITFL) and interosseous ligament (IOL) reconstruction techniques with autografts can yield better functional results by preserving its physiologic joint micromotion. 8…”