Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes

Abstract

Background: Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures. Methods: This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated. Results: All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period. Conclusion: Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation. Level of Evidence: Level IV.

Return to Play After Isolated Syndesmotic Ligamentous Injury in Athletes: A Systematic Review and Meta-analysis

“…Moreover, the pooled RTP for surgically treated cases was 70.94 days (95% CI 47.04, 94.85, P < .001), whereas it was 39.33 days (95% CI 28.78, 49.88, P < .001) for nonsurgical management (Figures 4 and 5). Among surgically treated cases, the lowest mean for RTP was reported by Taylor et al 29 (41 days), whereas the highest means for RTP were reported by Jain et al, 12 Kim et al, 13 and D’Hooghe et al 4 (103 days). Furthermore, among the studies that used the nonsurgical approach, the lowest mean for RTP was reported by Nussbaum et al 21 (13 days), and the highest mean for RTP was reported by and Sman et al 27 (61 days).…”

“…Five studies reported the recurrent injuries that occurred among their patients with syndesmotic injuries. Kim et al 13 reported 2 ankle sprains after RTP; 1 patient suffered an eversion sprain and was able to RTP after 2 weeks, another player sustained a recurrent anterior inferior tibiofibular ligament injury and was treated with allograft reconstruction. Osbahr et al 22 reported 2 recurrent syndesmotic sprains, both injuries occurred during a competitive match and resulted in 4 and 16 days of time lost from participation for a recurrent grade I and grade II sprain, respectively.…”

“…Five studies reported the recurrent injuries that occurred among their patients with syndesmotic injuries. Kim et al 13 reported 2 ankle sprains after RTP; 1 patient suffered an eversion sprain and was able to RTP after 2 weeks, another player sustained a recurrent anterior inferior tibiofibular ligament injury and was treated with allograft reconstruction. Osbahr et al 22…”

Anterior Inferior Tibiofibular Ligament Suture Tape Augmentation for Isolated Syndesmotic Injuries

“…This study adds to the growing body of literature supporting the use of direct syndesmosis ligament repair, 16 specifically for additional rotational constraint. AITFL augmentation may be a good operative alternative for isolated syndesmotic injuries without significant fibular displacement, injuries that primarily involve damage to the AITFL, abnormal syndesmotic anatomy, or in revision settings.…”

“…AITFL augmentation may be a good operative alternative for isolated syndesmotic injuries without significant fibular displacement, injuries that primarily involve damage to the AITFL, abnormal syndesmotic anatomy, or in revision settings. A recent clinical study by Kim et al 16 showed excellent clinical results and early return to play for athletes treated for isolated unstable syndesmotic injuries without fibula fractures using suture anchor fixation of the AITFL. Further clinical trials are needed to determine the role for ST augmentation of the AITFL in syndesmotic injuries.…”