Abstract
Purpose
The purpose of this study is to systematically review and meta-analyse the available literature on the treatment of chronic syndesmotic injuries of the ankle.
Methods
A systematic review of the PubMed/MEDLINE and EMBASE databases was conducted in August 2012 utilizing the keywords (treatment OR intervention) AND (injury OR sprain OR rupture) AND (syndesmosis OR syndesmotic OR “high ankle” OR “anterior inferior tibiofibular ligament” OR AITFL OR “posterior inferior tibiofibular ligament” OR PITFL OR tibiofibular diastasis). Studies that reported the outcomes of the surgical treatment of chronic syndesmotic injury were included in our review. Chronic was defined as symptoms longer than 6 months. Meta-analysis based on random-effects models was performed to pool the rates of success for different treatment methods.
Results
The search yielded 416 publications from PubMed/MEDLINE and 473 publications from EMBASE. After abstract and full-text review, 15 articles were included in this review. Treatment methods were placed into three broad surgical treatment categories: screw fixation, arthrodesis and arthroscopic debridement. The most common treatment strategy employed was screw fixation. The pooled rates of success for screw fixation, arthrodesis and arthroscopic debridement were 87.9, 79.4 and 78.7 %, respectively.
Conclusion
The current evidence on the treatment of chronic syndesmosis injuries in the ankle is limited to prospective and retrospective case series. The pooled success rates for screw fixation, arthrodesis and arthroscopic debridement each exceeded 78 %. Future high-level studies are required to discern the most appropriate treatment strategy(ies) for chronic syndesmotic injuries of the ankle.
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Appendix: Newcastle Ottawa Quality Assessment Scale
Appendix: Newcastle Ottawa Quality Assessment Scale
Adjusted for case series by Zengerink et al. [27]
Study design
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1.
Type of study
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a.
Prospective
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b.
Retrospective
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c.
Other
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d.
Not described
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a.
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2.
Set-up
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a.
According to protocol
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b.
Without protocol
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c.
No protocol described
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a.
Selection
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1.
Representatives of included patients
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a.
Truly representative of the average chronic syndesmosis patient in the community
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b.
Somewhat representative of the average chronic syndesmosis patient in the community
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c.
Selected group of patients by surgeon
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d.
No description of the derivation of the patient group
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a.
Outcome
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1.
Assessment of outcome
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a.
Independent blind assessment
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b.
Record linkage
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c.
Self-report
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d.
No description
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a.
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2.
Adequacy of follow-up of series
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a.
Complete follow-up—all subjects accounted for
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b.
Subjects lost to follow-up unlikely to introduce bias—small number loss (<5 %)
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c.
Follow-up rate is <95 % and no description of those lost
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d.
No statement
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a.
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Parlamas, G., Hannon, C.P., Murawski, C.D. et al. Treatment of chronic syndesmotic injury: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 21, 1931–1939 (2013). https://doi.org/10.1007/s00167-013-2515-y
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DOI: https://doi.org/10.1007/s00167-013-2515-y