Evaluation and management of ankle syndesmosis injuries

Mulligan, Edward P.

Affiliations

¹UT Southwestern Medical Center School of Health Professions, Department of Physical Therapy, 5323 Harry Hines Blvd, Dallas, TX 75390-8876, United States

Abstract and keywords

Background: >Ankle injuries are common in sporting activities with damage to the inferior tibiofibular ligaments being notable for their resultant disability and prolonged recovery.

Objective: To provide a synopsis of the current best evidence regarding the recognition and treatment of injury to the syndesmotic ligaments of the ankle.

Design: Structured narrative overview.

Methods: Keyword search of Medline, CINAHL, and PEDro databases for studies published in English from January 1985 to July 2010. In addition, the reference lists from articles obtained were manually searched for relevant literature.

Summary: This manuscript provides an overview of the distal tibiofibular pathologies, discusses the accuracy, limitations, and prognostic ability of clinical and radiographic examination techniques, and presents a philosophical approach to the rehabilitative management of syndesmotic injuries that integrates known biomechanical influences.

Conclusion: An appreciation for the mechanism of injury and a careful examination can distinguish these injuries from other forms of ankle instability. Proper recognition and immediate attention to the unique complexities of this joint can minimize morbidity and prevent a delayed return to sports.

Keywords: Ankle injuries; Tibiofibular joint; Syndesmosis; Review

Links

DOI: 10.1016/j.ptsp.2011.03.001

PubMed: 21496767

WoS: 000291073100003

History

Received: 2010-11-16

Revised: 2011-03-7

Accepted: 2011-03-9

Online: 2011-04-2

Cited Works (31)

Year	Entry
2007	Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. July 2007;35(7):1197-1207.
2006	Fites B, Kunes J, Madaleno J, Silvestri P, Johnson DL. Latent syndesmosis injuries in athletes. Orthopedics. February 2006;29(2):124-127.
1994	Ward DW. Syndesmotic ankle sprain in a recreational hockey player. J Manip Physiol Ther. July–August 1994;17(6):384-394.
1997	Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. November 1997;18(11):693-698.
1998	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. October 1998;19(10):653-660.
2005	Lindenfeld T, Parikh S. Clinical tip: heel-thump test for syndesmotic ankle sprain. Foot Ankle Int. June 2005;26(5):406-408.
2006	Evans JM, Schucany WG. Radiological evaluation of a high ankle sprain. Proc (Bayl Univ Med Cent). October 2006;19(4):402-405.
1992	Taylor DC, Englehardt DL, Bassett FH III. Syndesmosis sprains of the ankle: the influence of heterotopic ossification. Am J Sports Med. March 1992;20(2):146-150.
2009	Coetzee JC, Ebeling PB. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs tightrope® fiber wire fixation – medium term results. South Afr Orthop J. Autumn, 2009;8(1):32-37.
2003	Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis: the role of arthroscopy of the ankle. J Bone Joint Surg. April 2003;85B(3):324-329.
2008	Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg. April 2008;90B(4):405-410.
2009	Press CM, Gupta A, Hutchinson MR. Management of ankle syndesmosis injuries in the athlete. Curr Sports Med Rep. September–October 2009;8(5):228-233.
2001	Nussbaum ED, Hosea TM, Sieler SD, Incremona BR, Kessler DE. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med. January 2001;29(1):31-35.
1994	Ogilvie-Harris DJ, Reed SC, Hedman TP. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy. October 1994;10(5):558-560.
2010	Miller AN, Paul O, Boraiah S, Parker RJ, Helfet DL, Lorich DG. Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma. January 2010;24(1):12-16.
2002	Clanton TO, Paul P. Syndesmosis injuries in athletes. Foot and Ankle Clinics. September 2002;7(3):529-549.
2007	Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. June 2007;15(6):330-339.
1994	Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma. June 1994;8(3):215-219.
1991	Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294-298.
2003	Oae K, Takao M, Naito K, Uchio Y, Kono T, Ishida J, Ochi M. Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. Radiology. April 2003;227(1):155-161.
2004	Beumer A, van Hemert WLW, Niesing R, Entius CA, Ginai AZ, Mulder PGH, Swierstra BA. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res. 2004;423:227-234.
2006	Lin C-F, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. June 2006;36(6):372-384.
1990	Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. June 1990;10(6):325-330.
1995	Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg. June 1995;77A(6):847-856.
2002	Beumer A, Swierstra BA, Mulder PGH. Clinical diagnosis of syndesmotic ankle instability: evaluation of stress tests behind the curtains. Acta Orthop Scand. December 2002;73(6):667-669.
2005	Kiter E, Bozkurt M. The crossed-leg test for examination of ankle syndesmosis injuries. Foot Ankle Int. February 2005;26(2):187-188.
2001	Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train. January–March 2001;36(1):68-73.
1998	Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther. April 1998;27(4):276-284.
2004	Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in National Hockey League players. Am J Sports Med. December 2004;32(8):1941-1945.
2009	Mei-Dan O, Kots E, Barchilon V, Massarwe S, Nyska M, Mann G. A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes: a preliminary study. Am J Sports Med. May 2009;37(5):1009-1016.
1999	Doughtie M. Syndesmotic ankle sprains in football: a survey of National Football League athletic trainers. J Athl Train. March 1999;34(1):15-18.

Cited By (4)

Year	Entry
2020	Reuter S. Angewandte Sportphysiotherapie - Untere Extremität: Evidenz Für Befund Und Behandlung [in German]. Berlin: Springer; 2020.
2016	Weisskopf L, Röhm J, Hesse T. Ice hockey. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:491-495.
2013	Yang Y, Zhou J, Li B, Zhao H, Yu T, Yu G. Exploração operatória e redução de sindesmose em lesão de tornozelo de Weber tipo C = Operative exploration and reduction of syndesmosis in Weber type C ankle injury. Acta Ortop Bras. 2013;21(2):103-108.
2013	Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. July 2013;47(10):620-628.