Minimally Invasive Management of Syndesmotic Injuries

  • Stefan BuchmannEmail author
  • Umile Giuseppe Longo
  • Andreas B. Imhoff


Ankle sprains are one of the most common foot injuries, and the severity and degree of these injuries vary greatly.18 Their complexity remains a diagnostic and therapeutic challenge.11 Syndesmotic injuries occur less often in the general and sport populations when compared with lateral ankle sprains, with a reported incidence from 1% to 11% of all ankle injuries.21 They usually require a longer recovery period than lateral ankle sprains.21 Though the injury of the syndesmosis is the most important predictive factor for chronic ankle dysfunction 6 months after ankle sprains,14,19 diagnostic protocols, which include physical examination, radiographs, stress examinations and MRI, do not completely quantify the extent of ligament damage.13


External Rotation Ankle Sprain Deltoid Ligament Tibiofibular Ligament Lateral Ankle Sprain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Arthrex. Tight rope syndesmosis fixation - surgical technique. Available at: 2009
  2. 2.
    Beumer A, Heijboer R, Fontijne WP, Swierstra BA. Late reconstruction of the anterior distal tibiofibular syndesmosis: good outcome in 9 patients. Acta Orthop Scand. 2000;71:519–521.PubMedCrossRefGoogle Scholar
  3. 3.
    Beumer A, Valstar ER, Garling EH. External rotation stress imaging in syndesmotic injuries of the ankle: comparison of lateral radiography and radiostereometry in a cadaveric model. Acta Orthop Scand. 2003;74:201–205.PubMedCrossRefGoogle Scholar
  4. 4.
    Bridgman SA, Clement D, Downing A, Walley G, Phair I, Maffulli N. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J. 2003;20:508–510.PubMedCrossRefGoogle Scholar
  5. 5.
    Brostrom L. Sprained ankles. V. Treatment and prognosis in recent ligament ruptures. Acta Orthop Scand. 1966;132:537–550.Google Scholar
  6. 6.
    Brown KW, Morrison WB, Schweitzer ME, Parellada JA, Nothnagel H. MRI findings associated with distal tibiofibular syndesmosis injury. Am J Roentgenol. 2004;182:131–136.CrossRefGoogle Scholar
  7. 7.
    Capasso G, Maffulli N, Testa V. Ankle taping: support given by different materials. Br J Sports Med. 1989;23:239–240.PubMedCrossRefGoogle Scholar
  8. 8.
    Coetzee JC, Ebeling P. Treatment of syndesmosis disruptions with tightrope fixation. Techn Foot Ankle Surg. 2008;7:196–202.CrossRefGoogle Scholar
  9. 9.
    Cottom JM, Hyer CF, Philbin TM, Berlet GC. Treatment of syndesmotic disruptions with the Arthrex Tightrope: a report of 25 cases. Foot Ankle Int. 2008;29:773–780.PubMedCrossRefGoogle Scholar
  10. 10.
    Nussbaum ED, Hosea TM, Sieler SD, Incremona BR, Kessler DE. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am. J. Sports Med. 2001;29:31–35.PubMedGoogle Scholar
  11. 11.
    Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006;11:659–662.PubMedCrossRefGoogle Scholar
  12. 12.
    Frey C. Ankle sprains. Instr Course Lect. 2001;50:515–520.PubMedGoogle Scholar
  13. 13.
    Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int. 2006;27:788–792.PubMedGoogle Scholar
  14. 14.
    Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 2006;19:653–660.CrossRefGoogle Scholar
  15. 15.
    Grass R, Herzmann K, Biewener A, Zwipp H. [Injuries of the inferior tibiofibular syndesmosis]. Unfallchirurg. 2000;103:520–532.PubMedCrossRefGoogle Scholar
  16. 16.
    Grass R, Rammelt S, Biewener A, Zwipp H. Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular syndesmosis. Foot Ankle Int. 2003;24:392–397.PubMedGoogle Scholar
  17. 17.
    Harper M. An anatomic and radiologic investigation of the tibiofibular clear space. Foot Ankle Int. 1993;14:455–458.CrossRefGoogle Scholar
  18. 18.
    Malliaropoulos N, Ntessalen M, Papacostas E, Longo UG, Maffulli N. Reinjury after acute lateral ankle sprains in elite track and field athletes. Am J Sports Med. 2009;37:1755–1761.PubMedCrossRefGoogle Scholar
  19. 19.
    Malliaropoulos N, Papacostas E, Papalada A, Maffulli N. Acute lateral ankle sprains in track and field athletes: an expanded classification. Foot Ankle Clin. 2006;11:497–507.PubMedCrossRefGoogle Scholar
  20. 20.
    McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int. 1997;18:262–266.PubMedCrossRefGoogle Scholar
  21. 21.
    Molinari A, Stolley M, Amendola A. High ankle sprains (syndesmotic) in athletes: diagnostic challenges and review of the literature. Iowa Orthop J. 2009;29:130–138.PubMedGoogle Scholar
  22. 22.
    Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. 1997;13:564–574.PubMedCrossRefGoogle Scholar
  23. 23.
    Mei-Dan O, Kots E, Barchilon V, Massarwe S, Nyska M, Mann G. A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes. Am J Sports Med. 2009;37:1009–1016.PubMedCrossRefGoogle Scholar
  24. 24.
    Press CM, Gupta A, Hutchinson MR. Management of ankle syndesmosis injuries in the athlete. Curr Sports Med Rep. 2009;8:228–233.PubMedGoogle Scholar
  25. 25.
    Salzmann GM, Walz L, Schoettle PB, Imhoff AB. Arthroscopic anatomical reconstruction of the acromioclavicular joint. Acta Orthop Belg. 2008;74:397–400.PubMedGoogle Scholar
  26. 26.
    Soin SP, Knight TA, Dinah AF, Mears SC, Swierstra BA, Belkoff SM. Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison. Foot Ankle Int. 2009;30:346–352.PubMedCrossRefGoogle Scholar
  27. 27.
    Takao M, Ochi M, Naito K. Arthroscopic diagnosis of the tibiofibular syndesmosis disruption. Arthroscopy. 2001;17:836–843.PubMedGoogle Scholar
  28. 28.
    Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis: the role of arthroscopy of the ankle. J Bone Joint Surg Br. 2003;85:324–329.PubMedCrossRefGoogle Scholar
  29. 29.
    Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007;35:1833–1838.PubMedCrossRefGoogle Scholar
  30. 30.
    Thornes B, McCartan D. Ankle syndesmosis injuries treated with the tightRope Suture-Button kit. Tech Foot Ankle Surg. 2006;5:45–53.CrossRefGoogle Scholar
  31. 31.
    Thornes B, Walsh A, Hislop M, Murray P, O’Brien M. Suture-Endobutton fixation of ankle tibio-fibular diastasis: a Cadaver study. Foot Ankle Int. 2003;24:142–146.PubMedGoogle Scholar
  32. 32.
    Tornetta P 3rd, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am. 2001;83:489–492.PubMedGoogle Scholar
  33. 33.
    Uys HD, Rijke AM. Clinical association of acute lateral ankle sprain with syndesmotic involvement: a stress radiography and magnetic resonance imaging study. Am J Sports Med. 2002;30:816–822.PubMedGoogle Scholar
  34. 34.
    van den Bekerom MP, Hogervorst M, Bolhuis HW, van Dijk CN. Operative aspects of the syndesmotic screw: review of current concepts. Injury. 2008;39:491–498.PubMedCrossRefGoogle Scholar
  35. 35.
    Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med. 2008;36:2398–2406.PubMedCrossRefGoogle Scholar
  36. 36.
    Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35:1197–1207.PubMedCrossRefGoogle Scholar
  37. 37.
    Willmott HJ, Singh B, David LA. Outcome and complications of treatment of ankle diastasis with tightrope fixation. Injury. 2009;40:1204–1206PubMedCrossRefGoogle Scholar
  38. 38.
    Wolf BR, Amendola A. Syndesmosis injuries in the athlete: when and how to operate. Curr Opin Orthop. 2002;13:151–154.CrossRefGoogle Scholar
  39. 39.
    Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am. 1995;77:847–856.PubMedGoogle Scholar

Copyright information

© Springer London 2010

Authors and Affiliations

  • Stefan Buchmann
    • 1
    Email author
  • Umile Giuseppe Longo
  • Andreas B. Imhoff
  1. 1.Department of Orthopaedic Sports Medicine, Klinikum Rechts der IsarUniversity of MunichMunichGermany

Personalised recommendations