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Erschienen in: Sports Medicine 2/2014

01.02.2014 | Review Article

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

verfasst von: Timothy L. Miller, Timothy Skalak

Erschienen in: Sports Medicine | Ausgabe 2/2014

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Abstract

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.
Literatur
1.
Zurück zum Zitat van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456–63.PubMedCrossRef van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456–63.PubMedCrossRef
2.
Zurück zum Zitat Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in national hockey league players. Am J Sports Med. 2004;32(8):1941–5.PubMedCrossRef Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in national hockey league players. Am J Sports Med. 2004;32(8):1941–5.PubMedCrossRef
3.
Zurück zum Zitat Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. 1989;17(2):282–5 (discussion 5–6). Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. 1989;17(2):282–5 (discussion 5–6).
4.
Zurück zum Zitat Porter DA. Evaluation and treatment of ankle syndesmosis injuries. Instr Course Lect. 2009;58:575–81.PubMed Porter DA. Evaluation and treatment of ankle syndesmosis injuries. Instr Course Lect. 2009;58:575–81.PubMed
5.
Zurück zum Zitat Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15(6):330–9.PubMed Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15(6):330–9.PubMed
6.
Zurück zum Zitat Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653–60.PubMedCrossRef Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653–60.PubMedCrossRef
7.
8.
Zurück zum Zitat Moseley JB, Chimenti BT. Foot and ankle injuries in the professional athlete. In: Baxter DE, editor. The foot and ankle in sport. New York: Mosby; 1995. p. 321–8. Moseley JB, Chimenti BT. Foot and ankle injuries in the professional athlete. In: Baxter DE, editor. The foot and ankle in sport. New York: Mosby; 1995. p. 321–8.
9.
Zurück zum Zitat Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006;36(6):372–84.PubMedCrossRef Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006;36(6):372–84.PubMedCrossRef
10.
Zurück zum Zitat Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294–8.PubMedCrossRef Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294–8.PubMedCrossRef
11.
Zurück zum Zitat Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10(6):325–30.PubMedCrossRef Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10(6):325–30.PubMedCrossRef
12.
Zurück zum Zitat Taylor DC, Englehardt DL, Bassett FH 3rd. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med. 1992;20(2):146–50.PubMedCrossRef Taylor DC, Englehardt DL, Bassett FH 3rd. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med. 1992;20(2):146–50.PubMedCrossRef
13.
Zurück zum Zitat Porter DA. Ligamentous injuries of the foot and ankle. In: Fitzgerald RH, Kaufer H, Malkani AL, editors. Orthopaedics. St. Louis: Mosby; 2002. Porter DA. Ligamentous injuries of the foot and ankle. In: Fitzgerald RH, Kaufer H, Malkani AL, editors. Orthopaedics. St. Louis: Mosby; 2002.
14.
15.
Zurück zum Zitat Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33(5):371–8.PubMedCrossRef Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33(5):371–8.PubMedCrossRef
16.
Zurück zum Zitat Lauge-Hansen N. Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction. AMA Arch Surg. 1952;64(4):488–500.PubMedCrossRef Lauge-Hansen N. Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction. AMA Arch Surg. 1952;64(4):488–500.PubMedCrossRef
17.
Zurück zum Zitat Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge–Hansen classification of ankle injuries. Radiographics. 2012;32(2):E71–84.PubMedCrossRef Okanobo H, Khurana B, Sheehan S, Duran-Mendicuti A, Arianjam A, Ledbetter S. Simplified diagnostic algorithm for Lauge–Hansen classification of ankle injuries. Radiographics. 2012;32(2):E71–84.PubMedCrossRef
18.
Zurück zum Zitat Lauge-Hansen N. Fractures of the ankle. III. Genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Rad Ther Nucl Med. 1954;71(3):456–71. Lauge-Hansen N. Fractures of the ankle. III. Genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Rad Ther Nucl Med. 1954;71(3):456–71.
19.
Zurück zum Zitat Fites B, Kunes J, Madaleno J, Silvestri P, Johnson DL. Latent syndesmosis injuries in athletes. Orthopedics. 2006;29(2):124–7.PubMed Fites B, Kunes J, Madaleno J, Silvestri P, Johnson DL. Latent syndesmosis injuries in athletes. Orthopedics. 2006;29(2):124–7.PubMed
20.
Zurück zum Zitat Clanton TO. Ankle sprains, ankle instability and syndesmosis injuries. In: Porter DA, Schon LC, editors. Baxter’s the foot and ankle in sport. 2nd ed. Philadelphia: Mosby; 2009. p. 273–390. Clanton TO. Ankle sprains, ankle instability and syndesmosis injuries. In: Porter DA, Schon LC, editors. Baxter’s the foot and ankle in sport. 2nd ed. Philadelphia: Mosby; 2009. p. 273–390.
21.
Zurück zum Zitat Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. 2012;6(6):6. Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. 2012;6(6):6.
22.
Zurück zum Zitat Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10(3):156–60.PubMedCrossRef Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10(3):156–60.PubMedCrossRef
23.
Zurück zum Zitat Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18(11):693–8.PubMedCrossRef Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18(11):693–8.PubMedCrossRef
24.
Zurück zum Zitat Beumer A, Campo MM, Niesing R, Day J, Kleinrensink GJ, Swierstra BA. Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury. 2005;36(1):60–4.PubMedCrossRef Beumer A, Campo MM, Niesing R, Day J, Kleinrensink GJ, Swierstra BA. Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury. 2005;36(1):60–4.PubMedCrossRef
25.
Zurück zum Zitat Gill JB, Risko T, Raducan V, Grimes JS, Schutt RC Jr. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am. 2007;89(5):994–9.PubMedCrossRef Gill JB, Risko T, Raducan V, Grimes JS, Schutt RC Jr. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am. 2007;89(5):994–9.PubMedCrossRef
26.
Zurück zum Zitat Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012;4(1):e5.CrossRef Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012;4(1):e5.CrossRef
27.
Zurück zum Zitat Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011;50(6):762–5.PubMedCrossRef Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011;50(6):762–5.PubMedCrossRef
28.
Zurück zum Zitat McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc. 2012;7(7):7. McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc. 2012;7(7):7.
29.
Zurück zum Zitat Amendola A, Williams G, Foster D. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains. Sports Med Arthrosc. 2006;14(4):232–6.PubMedCrossRef Amendola A, Williams G, Foster D. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains. Sports Med Arthrosc. 2006;14(4):232–6.PubMedCrossRef
30.
Zurück zum Zitat Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431(431):207–12.PubMedCrossRef Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431(431):207–12.PubMedCrossRef
32.
Zurück zum Zitat Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int. 2009;30(5):419–26.PubMedCrossRef Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int. 2009;30(5):419–26.PubMedCrossRef
33.
Zurück zum Zitat Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012;26(7):439–43.PubMedCrossRef Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012;26(7):439–43.PubMedCrossRef
34.
Zurück zum Zitat Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828–35.PubMedCrossRef Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828–35.PubMedCrossRef
35.
Zurück zum Zitat Cottom JM, Hyer CF, Philbin TM, Berlet GC. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620–30.PubMedCrossRef Cottom JM, Hyer CF, Philbin TM, Berlet GC. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620–30.PubMedCrossRef
36.
Zurück zum Zitat Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250–6.PubMedCrossRef Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250–6.PubMedCrossRef
37.
Zurück zum Zitat Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69–75.PubMedCrossRef Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69–75.PubMedCrossRef
38.
Zurück zum Zitat Massobrio M, Antonietti G, Albanese P, Necci F. Operative treatment of tibiofibular diastasis: a comparative study between transfixation screw and reabsorbable cerclage. Preliminary result. Clin Ther. 2011;162(6):e161–7. Massobrio M, Antonietti G, Albanese P, Necci F. Operative treatment of tibiofibular diastasis: a comparative study between transfixation screw and reabsorbable cerclage. Preliminary result. Clin Ther. 2011;162(6):e161–7.
39.
Zurück zum Zitat Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36(6):1199–206.PubMedCentralPubMedCrossRef Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36(6):1199–206.PubMedCentralPubMedCrossRef
40.
Zurück zum Zitat Teramoto A, Suzuki D, Kamiya T, Chikenji T, Watanabe K, Yamashita T. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med. 2011;39(10):2226–32.PubMedCrossRef Teramoto A, Suzuki D, Kamiya T, Chikenji T, Watanabe K, Yamashita T. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med. 2011;39(10):2226–32.PubMedCrossRef
41.
Zurück zum Zitat Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007;35(11):1833–8.PubMedCrossRef Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007;35(11):1833–8.PubMedCrossRef
42.
Zurück zum Zitat Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35(7):1197–207.PubMedCrossRef Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35(7):1197–207.PubMedCrossRef
43.
Zurück zum Zitat Press CM, Gupta A, Hutchinson MR. Management of ankle syndesmosis injuries in the athlete. Curr Sports Med Rep. 2009;8(5):228–33.PubMedCrossRef Press CM, Gupta A, Hutchinson MR. Management of ankle syndesmosis injuries in the athlete. Curr Sports Med Rep. 2009;8(5):228–33.PubMedCrossRef
44.
45.
Zurück zum Zitat Carr J. Malleolar fractures and soft tissue injuries of the ankle. In: Browner B, Jupiter J, Levine A, Trafton PG, editors. Skeletal trauma: fractures, dislocations, ligamentous injuries. Philadelphia: Saunders; 2003. p. 2307–74. Carr J. Malleolar fractures and soft tissue injuries of the ankle. In: Browner B, Jupiter J, Levine A, Trafton PG, editors. Skeletal trauma: fractures, dislocations, ligamentous injuries. Philadelphia: Saunders; 2003. p. 2307–74.
Metadaten
Titel
Evaluation and Treatment Recommendations for Acute Injuries to the Ankle Syndesmosis Without Associated Fracture
verfasst von
Timothy L. Miller
Timothy Skalak
Publikationsdatum
01.02.2014
Verlag
Springer International Publishing
Erschienen in
Sports Medicine / Ausgabe 2/2014
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-013-0106-1

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