Skip to main content
SpringerLink
Log in

Clinical outcomes of isolated acute instability of the syndesmosis treated with arthroscopy and percutaneous suture-button fixation

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

To present the short- to midterm clinical outcomes of a series of patients with isolated acute syndesmosis instability treated with arthroscopy and percutaneous suture-button fixation.

Materials and methods

A review of 17 patients treated through the arthroscopic approach. The mean age of the patients was 27.8 years and the mean follow-up was 31.5 months. Clinical and functional evaluations were based on the VAS, AOFAS ankle-hindfoot score and time of return to preinjury level of activities. Imaging analysis was performed with stress radiographs, MRI and CT scan with stress.

Results

The average VAS was 0.5 and the mean AOFAS score was 95.5. Out of the 17 patients, 15 were able to return to their preinjury level of activities. The mean time of return to activities was 5.06 months.

Conclusion

Arthroscopic approach and percutaneous suture-button fixation provided satisfactory clinical and functional results for selected patients with ASI at short- to midterm follow-up.

Level of evidence

Level IV, retrospective case series.

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
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Yuen CP, Lui TH (2017) Distal tibiofibular syndesmosis: anatomy, biomechanics injury and management. Open Orthop J. https://doi.org/10.2174/1874325001711010670

    Article  PubMed  PubMed Central  Google Scholar 

  2. Akoh CC, Phisitkul P (2019) Anatomic ligament repairs of syndesmotic injuries. Orthop Clin North Am

  3. Ogilvie-Harris DJ, Reed SC (1994) Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery. Arthroscopy. https://doi.org/10.1016/S0749-8063(05)80015-5

    Article  PubMed  Google Scholar 

  4. Valkering KP, Vergroesen DA, Nolte PA (2012) Isolated syndesmosis ankle injury. Orthopedics 35:e1705–e1710. https://doi.org/10.3928/01477447-20121120-13

    Article  PubMed  Google Scholar 

  5. Zamzami MM, Zamzam MM (2009) Chronic isolated distal tibiofibular syndesmotic disruption: diagnosis and management. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2008.04.002

    Article  PubMed  Google Scholar 

  6. Bartoníček J, Rammelt S, Kašper Š et al (2019) Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg 139:497–506. https://doi.org/10.1007/s00402-018-3099-2

    Article  PubMed  Google Scholar 

  7. Takao M, Ochi M, Oae K, et al (2003) Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br

  8. Lucas DE, Watson BC, Simpson GA et al (2016) Arthroscopic evaluation of syndesmotic instability and malreduction. Foot Ankle Spec. https://doi.org/10.1177/1938640016666913

    Article  PubMed  Google Scholar 

  9. Johnson ZA, Ryan PM, Anderson CD (2016) Arthroscopic stabilization for chronic latent syndesmotic instability. Arthrosc Tech. https://doi.org/10.1016/j.eats.2015.12.006

    Article  PubMed  PubMed Central  Google Scholar 

  10. Levack AE, Dvorzhinskiy A, Gausden EB et al (2020) Sagittal ankle position does not affect axial CT measurements of the syndesmosis in a cadaveric model. Arch Orthop Trauma Surg 140:25–31. https://doi.org/10.1007/s00402-019-03209-4

    Article  PubMed  Google Scholar 

  11. Park YH, Ahn JH, Choi GW, Kim HJ (2018) Comparison of clamp reduction and manual reduction of syndesmosis in rotational ankle fractures: a prospective randomized trial. J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2017.05.040

    Article  PubMed  Google Scholar 

  12. Cosgrove CT, Spraggs-Hughes AG, Putnam SM et al (2018) A novel indirect reduction technique in ankle syndesmotic injuries. J Orthop Trauma 32:361–367. https://doi.org/10.1097/BOT.0000000000001169

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gardner MJ, Graves ML, Higgins TF, Nork SE (2015) Technical considerations in the treatment of syndesmotic injuries associated with ankle fractures. J Am Acad Orthop Surg

  14. Sagi HC, Shah AR, Sanders RW (2012) The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. https://doi.org/10.1097/BOT.0b013e31822a526a

    Article  PubMed  Google Scholar 

  15. Tourné Y, Molinier F, Andrieu M et al (2019) Diagnosis and treatment of tibiofibular syndesmosis lesions. Orthop Traumatol Surg Res 105:S275–S286. https://doi.org/10.1016/j.otsr.2019.09.014

    Article  PubMed  Google Scholar 

  16. Watson BC, Lucas DE, Simpson GA et al (2015) Arthroscopic evaluation of syndesmotic instability in a cadaveric model. Foot Ankle Int. https://doi.org/10.1177/1071100715589631

    Article  PubMed  Google Scholar 

  17. Lee SH, Kim ES, Lee YK et al (2015) Arthroscopic syndesmotic repair: technical tip. Foot Ankle Int. https://doi.org/10.1177/1071100714551387

    Article  PubMed  Google Scholar 

  18. Zhang P, Liang Y, He J et al (2017) A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-017-1645-7

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kocadal O, Yucel M, Pepe M et al (2016) Evaluation of reduction accuracy of suture-button and screw fixation techniques for syndesmotic injuries. Foot Ankle Int 37:1317–1325. https://doi.org/10.1177/1071100716661221

    Article  PubMed  Google Scholar 

  20. Birnie MFN, van Schilt KLJ, Sanders FRK et al (2019) Anterior inferior tibiofibular ligament avulsion fractures in operatively treated ankle fractures: a retrospective analysis. Arch Orthop Trauma Surg 139:787–793. https://doi.org/10.1007/s00402-019-03138-2

    Article  PubMed  PubMed Central  Google Scholar 

  21. Laflamme M, Belzile EL, Bédard L et al (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 29:216–223. https://doi.org/10.1097/BOT.0000000000000245

    Article  PubMed  Google Scholar 

  22. Xie L, Xie H, Wang J, et al (2018) Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: a systematic review and meta-analysis. Int J Surg

  23. Schepers T (2012) Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop 36:1199–1206. https://doi.org/10.1007/s00264-012-1500-2

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Marcelo Pires Prado reports personal fees from Arthrex, Inc and personal fees from Geistlich, outside the submitted work.

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil

    Danilo Ryuko Cândido Nishikawa

  2. Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil

    Guilherme Honda Saito, Adilson Sanches de Oliveira Junior, Alberto Abussamra Moreira Mendes & Marcelo Pires Prado

  3. Faculdade de Medicina Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil

    Leticia Piovesana Devito

Authors
  1. Danilo Ryuko Cândido Nishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guilherme Honda Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adilson Sanches de Oliveira Junior
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Abussamra Moreira Mendes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leticia Piovesana Devito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcelo Pires Prado
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MPP and AAMM performed the operations. DRCN and MPP collected data. Material preparation was performed by all authors. First draft of the manuscript was written by DRCN and GHS, and all authors commented for adequate changes to its final version. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Danilo Ryuko Cândido Nishikawa.

Ethics declarations

Conflict of interest

DRCN, ASOJ, AAMM, and LPD: none. MPP: education consultant for Arthrex. GHS: education consultant for Wright.

Ethical approval

This study was performed in accordance with the Helsinki Declaration of 1964, and with the ethical standards of the institutional research committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishikawa, D.R.C., Saito, G.H., de Oliveira Junior, A.S. et al. Clinical outcomes of isolated acute instability of the syndesmosis treated with arthroscopy and percutaneous suture-button fixation. Arch Orthop Trauma Surg 141, 1567–1574 (2021). https://doi.org/10.1007/s00402-021-03813-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03813-3

Keywords

Search

Navigation