Treatment of syndesmotic disruptions with the Arthrex Tightrope (TM): A report of 25 cases
ABSTRACT The complexity of syndesmotic injuries, often with both bone and soft tissue injury mandates an expeditious diagnosis and treatment to avoid unfavorable long term outcomes. Various methods of fixation of the syndesmosis have been reported. We present the largest series evaluating the Arthrex Tightrope for management of syndesmotic injuries.
Twenty-five patients with disruption of the distal tibiofibular articulation underwent treatment with an Arthrex Tightrope. In 21 cases, a single tightrope was placed, and in four cases, two tightropes were utilized. Associated ankle fractures were treated using proper AO technique. Those patients with diabetes and/or neuroarthropathic changes foot or ankle were not included in this study. Postoperative evaluation parameters included radiographic measurements, a modified AOFAS scoring system and SF-12.
Average followup was 10.8 months. The mean time to full weightbearing was 5.5 (range, 2 to 8) weeks. Postoperative radiographic analysis of the mean distance from the tibial plafond to the placement of the tightrope(s), medial clear space, average postoperative tibiofibular overlap and the mean tibiofibular clear space demonstrated no evidence of re-displacement of the syndesmotic complex at an average of 10.8 (range, 6 to 12) months. The modified AOFAS hindfoot scoring scale and SF-12 both demonstrated significant improvements; preoperative values were assessed in the office with the first patient visit as they are incorporated into the patient intake form that each patient fills out at the initial visit.
Utilization of the tightrope in diastasis of the syndesmosis should be considered as a good option. The method of placement is quick, can be minimally invasive, and obviates the need for hardware removal. In this series, it maintained excellent reduction of the syndesmosis.
SourceAvailable from: Andrew Hsu
Article: Syndesmotic Injuries in Athletes[Show abstract] [Hide abstract]
ABSTRACT: Ligamentous injuries around the ankle are one of the most common injuries in athletes, and syndesmotic (high ankle) sprains are being diagnosed at an increasing rate in recent years. Syndesmotic injuries can lead to significant pain, disability, and time away from sport with prolonged rehabilitation. Advanced imaging with ultrasound, CT, and MRI have improved the detection of syndesmosis injury, and arthroscopy can confirm the diagnosis and help identify any additional intra-articular pathology. Recently, there has been increased interest and research surrounding the treatment of high-grade syndesmotic injuries in athletes with a focus on early rehabilitation and surgical intervention in select patients. Athletes can potentially return to training and play earlier if the syndesmosis is surgically stabilized, but the literature is controversial regarding the overall management of these injuries.Operative Techniques in Sports Medicine 09/2014; 22(4). DOI:10.1053/j.otsm.2014.09.003 · 0.21 Impact Factor
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ABSTRACT: Background: The accuracy of reduction of distal tibiofibular syndesmosis disruptions has been associated with the clinical outcome. Suture-button fixation of the syndesmosis is a dynamic alternative mode of fixation. We hypothesized that with deliberate clamp-induced malreduction, suture-button fixation of the syndesmosis would allow a more anatomic post-fixation position compared with screw fixation. Methods: Forty-eight syndesmotic fixations were performed on twelve through-knee cadaveric specimens. The syndesmosis was destabilized and off-axis clamping was used to produce both anterior and posterior malreduction patterns. In twelve scenarios (six anterior and six posterior malreductions), syndesmotic screw fixation was used, followed by computed tomography. With tenacula holding the malreduction, the syndesmosis screws were exchanged for a suture-button construct and the specimens underwent a subsequent computed tomography scan. In the other twelve scenarios, the suture-button fixation was achieved first, followed by screw fixation. Standardized measurements of anterior-posterior and medial-lateral fibular displacement were performed by two observers blinded to the method of fixation. Results: With anterior off-axis clamping, the mean sagittal malreduction was 2.7 +/- 2.0 mm with screw fixation and 1.0 +/- 1.0 mm with suture-button fixation (p = 0.02). With posterior off-axis clamping, the sagittal malreduction was 7.2 +/- 2.3 mm with screw fixation and 0.5 +/- 1.4 mm with suture-button fixation (p < 0.01). No differences were observed between fixation types in the coronal plane (p = 0.20 for anterior malreductions and p = 0.06 for posterior malreductions). Conclusions: With deliberate malreduction in a cadaver model, suture-button fixation of the syndesmosis results in less post-fixation displacement compared with screw fixation. The suture button's ability to allow for natural correction of deliberate malreduction was greatest with posterior off-axis clamping.The Journal of Bone and Joint Surgery 10/2014; 96(20):1732-8. DOI:10.2106/JBJS.N.00198 · 4.31 Impact Factor
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ABSTRACT: Injury to the tibiofibular syndesmosis often arises from external rotation force acting on the foot leading to eversion of the talus within the ankle mortise and increased dorsiflexion or plantar flexion. Such injuries can present in the absence of a fracture. Therefore, diagnosis of these injuries can be challenging, and often stress radiographs are helpful. Magnetic resonance imaging scans can be a useful adjunct in doubtful cases. The management of syndesmotic injuries remains controversial, and there is no consensus on how to optimally fix syndesmosis. This article reviews the mechanism of injury, clinical features and investigations performed for syndesmotic injuries and brings the reader up-to-date with the current evidence in terms of the controversies surrounding the management of these injuries.British Medical Bulletin 09/2014; 111(1):101-15. DOI:10.1093/bmb/ldu020 · 4.36 Impact Factor