Sports Medicine

, Volume 44, Issue 2, pp 179–188 | Cite as

Evaluation and Treatment Recommendations for Acute Injuries to the Ankle Syndesmosis Without Associated Fracture

  • Timothy L. MillerEmail author
  • Timothy Skalak
Review Article


Ankle ligamentous injuries are commonly seen in athletes in a variety of sports. Surveys of physicians and trainers of professional sports teams have identified syndesmotic injuries as among the most difficult to treat. In particular, injuries of the ankle syndesmosis have been strongly linked with a prolonged recovery and increased time to return to play. Due to sudden external rotation with the tibiotalar joint in dorsiflexion, these structures are commonly injured in association with fractures of the distal fibula. Surgery is indicated in cases with associated fractures and ligamentous instability, but optimal treatment for syndesmosis injuries without an associated fracture is less clear. A thorough history and physical examination, as well as appropriate imaging, are necessary to effectively diagnose and classify the injury. For stable injuries, short-term immobilization and functional rehabilitation is recommended. Unstable Grade 2 and 3 injuries require surgical fixation. Debate currently exists over rigid screw fixation versus suture button techniques as the ideal fixation method.


Deltoid Ligament Distal Fibula Tibial Plafond Syndesmotic Injury Suture Button 
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.



The authors received no funding for this study and report no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.The Ohio State University Sports Medicine CenterColumbusUSA
  2. 2.The Ohio State University College of Medicine and Public HealthColumbusUSA
  3. 3.Care Point Lewis CenterLewis CenterUSA

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