Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines
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The aim of the present study was to perform a systematic review of the current classification systems, and the clinical and radiological tests for the acute isolated syndesmotic injuries to identify the best method of classification and diagnosis allowing the surgeon to choose the appropriate management.
A systematic review of the literature according to the PRISMA guidelines has been performed. A comprehensive search using various combinations of the keywords “classification”, “grading system”, “ankle injury”, “ligament”, “syndesmotic injury”, “internal fixation”, “acute”, “synostosis”, “ligamentoplasties”, “clinical”, “radiological” over the years 1962–2015 was performed. The following databases were searched: MEDLINE, Google Scholar, EMBASE and Ovid.
The literature search resulted in 345 references for classification systems and 308 references for diagnosis methods, of which 283 and 295 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included 27 articles describing classification systems and 13 articles describing diagnostic tests for acute isolated syndesmotic injuries.
The ESSKA-AFAS consensus panel recommends distinguishing acute isolated syndesmotic injury as stable or unstable. Stable injuries should be treated non-operatively with a short-leg cast or brace, while unstable injuries should be managed operatively. The recommended clinical tests include: tenderness on palpation over the anterior tibiofibular ligament, the fibular translation test and the Cotton test. Radiographic imaging must include an AP view and a mortise view of the syndesmosis to check the tibiofibular clear space, medial clear space overlap, tibial width and fibular width.
Level of evidence
KeywordsSyndesmotic injury Acute Classification systems Diagnosis Imaging Clinical tests
- 7.Beumer A, Valstar ER, Garling EH, Niesing R, Ginai AZ, Ranstam J, Swierstra BA (2006) Effects of ligament sectioning on the kinematics of the distal tibiofibular syndesmosis: a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment. Acta Orthop 77(3):531–540CrossRefPubMedGoogle Scholar
- 24.Kim S, Huh YM, Song HT, Lee SA, Lee JW, Lee JE, Chung IH, Suh JS (2007) Chronic tibiofibular syndesmosis injury of ankle: evaluation with contrast-enhanced fat-suppressed 3D fast spoiled gradient-recalled acquisition in the steady state MR imaging. Radiology 242(1):225–235CrossRefPubMedGoogle Scholar
- 25.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentralGoogle Scholar