Skip to main content
SpringerLink
Log in

Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Suture button devices for tibiofibular syndesmosis injuries provide semirigid dynamic stabilization, but complications including knot irritation have been reported. No randomized trials of the new knotless suture button devices have been performed. We hypothesized that knotless suture button devices eliminate knot irritation and facilitate quicker return to sports. This study was performed to compare the clinical outcomes, complication rates, and time to return to sports between a new knotless suture button device and syndesmotic screw fixation.

Methods

This study included 54 patients treated for ankle syndesmotic injury from 2012 to 2014 with a knotless suture button device or syndesmotic screw fixation. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society score, Foot and Ankle Disability Index, Olerud and Molander score, and visual analog scale for pain and function. Secondary outcome measures were the complication rate and time required to return to sports. Patients underwent clinical and radiological evaluations preoperatively and three times during the 1-year postoperative follow-up.

Results

54 of 62 eligible patients were analyzed, median age 37 (18–60) and underwent the 1-year follow-up. The screw fixation and knotless suture button groups comprised 26 and 28 patients, respectively. The complication rate was significantly lower (p = 0.03) and time to return to sports was significantly shorter in the knotless suture button than screw fixation group (average, 14 versus 19 weeks, respectively; p = 0.006). No significant differences were identified in clinical outcomes or visual analog scale scores for pain and function between the groups. Age, injury mechanism, and body mass index did not significantly affect the time required to return to sports activities. The type of fixation was the only independent variable that reached statistical significance (p = 0.006).

Conclusion

Syndesmotic screw fixation and the new knotless suture button device both resulted in good clinical results. Lower complication rate and the earlier time to return to sports make the new knotless suture button device recommendable especially for highly active patients.

Level of evidence

Randomized controlled trial, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Beumer A, van Hemert WL, Niesing R et al (2004) Radiographic measure-ment of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 423:227–234

    Article  Google Scholar 

  2. Boytim MJ, Fischer DA, Neumann L (1991) Syndesmotic ankle sprains. Am J Sports Med 19(3):294–298

    Article  CAS  Google Scholar 

  3. Coetzee JC, Ebeling P (2009) Treatment of syndesmoses disruptions: a pro-spective, randomized study comparing conventional screw fixation vs TightRope fiber wire fixation—medium term results. South Afr Orthop J 8(1):32–37

    Google Scholar 

  4. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fractures—an increasing problem? Acta Orthop Scand 69(1):43–47

    Article  CAS  Google Scholar 

  5. Degroot H, Al-Omari AA, El Ghazaly SA (2011) Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int 32(3):250–256

    Article  Google Scholar 

  6. Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA (1997) Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int 18(11):693–698

    Article  CAS  Google Scholar 

  7. 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 19(10):653–660

    Article  CAS  Google Scholar 

  8. Hodgson P, Thomas R (2011) Avoiding suture knot prominence with suture button along distal fibula: technical tip. Foot Ankle Int 32 (9):908–909

    Article  Google Scholar 

  9. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH (1990) Syndesmosis sprains of the ankle. Foot Ankle 10(6):325–330

    Article  CAS  Google Scholar 

  10. Jordan TH, Talarico RH, Schuberth JM (2011) The radiographic fate of the syndesmosis after trans-syndesmotic screw removal in displaced ankle fractures. J Foot Ankle Surg 50:407–412

    Article  Google Scholar 

  11. Katznelson A, Lin E, Militiano J (1983) Ruptures of the ligaments about the tibio-fibular syndesmosis. Injury 15(3):170–172

    Article  CAS  Google Scholar 

  12. Kitaoka HB (1991) Salvage of nonunion following ankle arthrodesis for failed total ankle arthroplasty. Clin Orthop Relat Res 268:37–43

    Google Scholar 

  13. Kortekangas T, Savola O, Flinkkilä T et al (2015) A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury 46(6):1119–1126

    Article  Google Scholar 

  14. Laflamme M, Belzile EL, Bedard L, van den Bekerom MP, Glazebrook M, Pelet S (2015) A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma 29(5):216–223

    Article  Google Scholar 

  15. Lepojärvi S, Pakarinen H, Savola O, Haapea M, Sequeiros RB, Niinimäki J (2014) Posterior translation of the fibula may indicate malreduction: CT study of normal variation in uninjured ankles. J Orthop Trauma 28(4):205–209

    Article  Google Scholar 

  16. Martin RL, Irrgang JJ, Burdett RG, ContiSF, Van Swearingen JM (2005) Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int 26(11):968–983

    Article  Google Scholar 

  17. Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N (2012) Fixation of ankle syndesmotic injuries: comparison of TightRope fixation and sydesmotic screw fixation for accuracy of syndesmostic reduction. Am Sports Med 40(12):2828–2835

    Article  Google Scholar 

  18. Naqvi GA, Shafqat A, Awan N (2012) Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification. Injury 43(6):838–842

    Article  Google Scholar 

  19. Needleman RL, Skrade DA, Stiehl JB (1989) Effect of the syndesmotic screw on ankle motion. Foot Ankle 10(1):17–24

    Article  CAS  Google Scholar 

  20. Nilsson GM, Eneroth M, Ekdahl CS (2013) The Swedish version of OMAS is a reliable and valid outcome measure for patients with ankle fractures. BMC Musculoskelet Disord 25:14:109

    Article  Google Scholar 

  21. Olerud C, Molander H (1984) A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 103(3):190–194

    Article  CAS  Google Scholar 

  22. Pakarinen HJ, Flinkkilä TE, Ohtonen PP et al (2011) Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A Prospective Randomized Study. Foot Ankle Int 32(12):1103–1119

    Article  Google Scholar 

  23. Peterson KS, Chapman WD, Hyer CF, Berlet GC (2015) Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair. Foot Ankle Int 36(6):679–684

    Article  Google Scholar 

  24. Rammelt S, Schneiders W, Grass R, Rein S, Zwipp H (2011) Bandverletzungen am oberen Sprunggelenk. Z Orthop Unfall 149(5):e45–e67

    Article  CAS  Google Scholar 

  25. Rigby RB, Cottom JM (2013) Does the Arthrex TightRope®provide maintenance of the distal tibiofibular syndesmosis? A 2-year follow-up of 64 TightRopes® in 37 patients. J Foot Ankle Surg 52(5):563–567

    Article  Google Scholar 

  26. Sagi HC, Shah AR, Sanders RW (2012) The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma 26(7):439–443

    Article  Google Scholar 

  27. Schepers T (2012) Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop 36(6):1199–1206

    Article  Google Scholar 

  28. Seitz WH Jr, Bachner EJ, Abram LJ et al (1991) Repair of the tibiofibular syndesmosis with a flexibel implant. J Orthop Trauma 5(1):78–82

    Article  Google Scholar 

  29. Storey P, Gadd RJ, Blundell C, Davies MB (2012) Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int 33(9):717–721

    Article  Google Scholar 

  30. Stuart K, Panchbhavi VK (2011) The fate of syndesmotic screws. Foot Ankle Int 32(5):519–525

    Article  Google Scholar 

  31. Taylor DC, Enlehardt DL, Bassett FH 3rd (1992) Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med 20(2):146–150

    Article  CAS  Google Scholar 

  32. Thornes B, Shannon F, Guiney AM, Hession P, Masterson E (2005) Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat res 431:207–212

    Article  Google Scholar 

  33. Tucker A, Street J, Kealey D, McDonald S, Stevenson M (2013) Functional outcomes following syndesmotic fixation: a comparison of screws retained in situ versus routine removal – Is it really necessary? Injury 44(12):1880–1884

    Article  Google Scholar 

  34. Weckbach S, Hahnhaussen J, Losacco JT, Gebhard F, Stahel PF (2014) Is the standard retention of syndesmotic positioning screws after ankle fracture fixation safe and feasible? A retrospective cohort study in 140 consecutive patients at a North American Trauma Centre. Z Orthop Unfall 152(6):554–557

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Evangelical Hospital Bethel, Bielefeld, Germany

    Christian Colcuc

  2. Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    Christian Colcuc, Marc Blank & Reinhard Hoffmann

  3. Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    Thomas Stein

  4. Department of Sports Science, University of Bielefeld, Bielefeld, Germany

    Thomas Stein

  5. University Hospital Frankfurt am Main, Frankfurt, Germany

    Florian Raimann

  6. Institute of Sports Medicine and Trauma Department, Hannover Medical School, Hannover, Germany

    Sanjay Weber-Spickschen

  7. Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    Sebastian Fischer

Authors
  1. Christian Colcuc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Blank
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florian Raimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sanjay Weber-Spickschen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sebastian Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Reinhard Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Colcuc.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The authors declare that there was no funding of this study.

Ethical approval

The institutional ethics committee gave the approval to all data collections and randomizing procedures.

Informed consent

All patients provided written informed consent prior to participation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Colcuc, C., Blank, M., Stein, T. et al. Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device. Knee Surg Sports Traumatol Arthrosc 26, 3156–3164 (2018). https://doi.org/10.1007/s00167-017-4820-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4820-3

Keywords

Search

Navigation