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Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence.

Methods

In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions.

Results

Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far.

Conclusion

The meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant.

Level of evidence

Level I.

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Funding

Funding was not provided.

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Authors and Affiliations

  1. Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy

    Domenico Marasco, Jacopo Russo, Antonio Izzo, Salvatore Vallefuoco, Francesco Coppola, Francesco Smeraglia, Giovanni Balato, Massimo Mariconda & Alessio Bernasconi

  2. Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK

    Shelain Patel

Authors
  1. Domenico Marasco
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  2. Jacopo Russo
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  3. Antonio Izzo
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  4. Salvatore Vallefuoco
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  5. Francesco Coppola
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  6. Shelain Patel
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  7. Francesco Smeraglia
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  8. Giovanni Balato
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  9. Massimo Mariconda
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  10. Alessio Bernasconi
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Correspondence to Alessio Bernasconi.

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Marasco, D., Russo, J., Izzo, A. et al. Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 29, 3534–3542 (2021). https://doi.org/10.1007/s00167-021-06721-6

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