Current trends in the diagnosis and management of syndesmotic injury
- 790 Downloads
Ideal management of the various presentations of syndesmotic injury remains controversial to this day. High quality evidentiary science on this topic is rare, and numerous existing studies continue to contradict one another. The primary reasons for these discrepancies are that previous studies have failed to (1) properly distinguish between isolated (non-fractured) and non-isolated injuries, (2) accurately define stable from unstable injuries, and (3) sufficiently differentiate between acute and chronic injuries. The purpose of this review is to summarize today’s body of literature regarding diagnosis and management of syndesmotic injury and discuss current trends and important future directions to optimize care of this very heterogeneous population.
KeywordsSyndesmosis Syndesmotic injury Ankle fracture High ankle sprain
Compliance with ethical standards
Conflict of interest
Matthew L. Vopat, Bryan G. Vopat, and Bart Lubberts declare that they have no conflict of interest.
Christopher W. DiGiovanni reports stock options with Wright Medical, Paragon 28, and CreOsso. He is a consultant for Wright Medical and Extremity Medical. He also reports royalties from Extremity Medical.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 10.Cancienne JM, Crosen MP, Yarboro SR. Use of a hybrid operating room to improve reduction of syndesmotic injuries in ankle fractures: a case report. J Foot Ankle Surg. 2015.Google Scholar
- 14.• Lubberts B, van Dijk PAD, Donovan N. Stable and unstable grade II syndesmotic injuries require different treatment strategies and vary in fuctional outcomes: a systematic review. JISAKOS. 2016;1(3):1–6. An in-depth review of current recommendations on how to diagnosis and treat stable and unstable grade II syndesmotic injuries Google Scholar
- 17.Kaplan LD, et al. Incidence and variance of foot and ankle injuries in elite college football players. Am J Orthop (Belle Mead NJ). 2011;40(1):40–4.Google Scholar
- 18.Lubberts B, van Dijk PAD, Calder JD, DiGiovanni CW. There is no best surgical treatment for chronic isolated syndesmotic instability: a systematic review. J ISAKOS. 2016;1(5).Google Scholar
- 19.• Lilyquist M, et al. Cadaveric analysis of the distal tibiofibular syndesmosis. Foot Ankle Int. 2016. Cadaveric study that evaluated the anatomy of distal tibiofibular syndesmosis and the incidence of a prominet tranverse ligament. They found the transverse ligament was only prominent 70% of the time . Google Scholar
- 20.• van Dijk CN, et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1200–16. A literature review by ESSKA-AFAS where they described consensus guidelines for classification and diagnosis of acute isolated syndesmotic injuries CrossRefPubMedGoogle Scholar
- 23.• Watson BC, et al. Arthroscopic evaluation of syndesmotic instability in a cadaveric model. Foot Ankle Int. 2015;36(11):1362–8. Cadaveric study that evaluated how a physician can evaluate syndesmotic instability in multiple planes using arthroscopy. The authors found stability in the sagittal plane is more accurate to diagnosis syndesmotic instability when compared to the coronal plane CrossRefPubMedGoogle Scholar
- 24.• Calder JD, et al. Stable versus unstable grade II high ankle sprains: a prospective study predicting the need for surgical stabilization and time to return to sports. Arthroscopy. 2016;32(4):634–42. This study presents describes a possible method to arthroscopically diagnose syndesmotic instability in grade II high ankle sprains. Also, this study compared how different physical exam tests correlated with stability of the syndesmosis by accessing this arthroscopically Google Scholar
- 55.• van Dijk CN, et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1217–27. This is a literature review by ESSKA-AFAS that described consensus guidelines for conservative and surgical management of acute dislocated syndesmotic injuries CrossRefPubMedGoogle Scholar
- 69.Kelikian H, Kelikian A. Disorders of the ankle. Philadelphia: WB Saunders; 1985.Google Scholar
- 70.Hansen Jr ST, Repair of distal tibiofibular syndesmosis. In Functional construction of the foot and ankle. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 507–508.Google Scholar