Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study

Abstract

ObjectivesTo evaluate time to return to play following surgical stabilisation of isolated unstable syndesmosis injuries in a cohort of professional male football players.MethodsAll professional football players undergoing surgery for isolated unstable syndesmosis injury (West Point grade ≥IIB) at a specialised Orthopaedic and Sports Medicine Hospital were followed up until return to play (minimum ≥6 months). Players with a stable syndesmosis, injuries older than 6 weeks, concomitant medial or lateral malleolar fracture or previous ankle surgery were excluded. During rehabilitation, time required to return to sports-specific rehabilitation, team training and first match play, were recorded.ResultsBetween January 2012 and December 2017, a total of 110 male professional football players were included. The mean time required to begin on field rehabilitation was 37±12 days, while the mean time to return to team training was 72±28 days. The first official match was played on average 103±28 days postoperatively. Multivariable analysis revealed that the severity of injury, the concomitant presence of talar cartilage injury and the age of the player were significantly associated (p<0.00001) with time to return to on field rehabilitation, team training and match play.ConclusionIn this cohort of professional football players, surgical stabilisation of isolated unstable syndesmosis injuries (West Point grade ≥IIB) allowed for relatively quick return to play. High grade injury (West Point grade III), concomitant cartilage injury and greater age were associated with longer return to play times.Level of evidenceLongitudinal observational cohort study (level II).

Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies

“…Although various authors have recommended arthroscopy [ 11 , 14 , 38 ], only one study mentioned chondral lesions detected by arthroscopy. Unfortunately, these were only reported as a side note, and neither their severity nor their treatment was documented [ 8 ]. Consequently, no study has yet in detail assessed the frequency of intra-articular pathologies in patients suffering an acute isolated, unstable syndesmotic injury.…”

Towards Automated Ligamentous Injury Evaluation in Syndesmotic Ankle Lesions

“…Secondly, our clinical cohort consisted of a small amount of patients with syndesmotic lesions included, which might impair the generalizability of the findings. However, all patients were carefully selected after a detailed arthroscopic examination, which is currently considered as the gold standard in detecting syndesmotic ankle injuries (36,37). With regard to confirm the findings of our study, future research should therefore focus on the inclusion of more patients with high ankle sprains, as well as inclusion of healthy asymptomatic control patients from similar age groups.…”

Acute foot and ankle injuries and time return to sport

“…Flexible devices were the preferred fixation construct (47.1%), followed by screws (29.6%), hybrid fixation (18%), and other (5.3%) (Figure 2). From our survey collection, we were able to infer that regardless of the severity of the injury to the syndesmosis, device choice and return to play protocol were not consistent internationally although the mean values of survey responses and those in D'Hooghe et al [13] were strikingly similar.…”

“…Similarly, there is no current consensus on a return to sport protocol for athletes to return to play following a syndesmotic injury. Data from a large study group [13] revealed that the mean time to begin on-field/sport-specific rehabilitation was 37 ± 12 days, with a mean time of 103 ± 28 days to the first match after syndesmotic stabilization [13].…”