Article

Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains.

Department of Surgery, Division of Orthopaedic Surgery, Box 3615, Duke University Medical Center, Durham, NC 27710, USA.
The American journal of sports medicine (impact factor: 3.61). 12/2007; 35(11):1833-8. DOI:10.1177/0363546507304666 pp.1833-8
Source: PubMed

ABSTRACT Grade III syndesmosis sprains are usually treated with internal fixation. Limited information is available on early weightbearing and early return to activity after operative treatment for grade III syndesmosis sprains.
Treatment of grade III syndesmosis sprains in intercollegiate athletes with internal fixation, early range of motion, and early weightbearing can lead to rapid return to sport with minimal complications and no ankle problems in midterm follow-up.
Case series; Level of evidence, 4.
We evaluated a consecutive series of intercollegiate athletes treated operatively with 4.5-mm cortical screw fixation for grade III syndesmosis sprains. At 1 week after surgery, patients were allowed to begin range of motion exercises, progressive weightbearing, and gradually return to full activity as tolerated. Outcome measures included time to return to full activity and, at final follow-up, the Sports Ankle Rating System scores.
Six male intercollegiate college athletes met the inclusion criteria for this study. The average time for return to full activity was 41 days (range, 32-48 days). There were no intraoperative complications or complications when resuming in-season sport activities with the screw in place. One screw broke during removal. At an average follow-up of 34.3 months, using the Sports Ankle Rating System, the average clinical rating score was 96.2, the average quality-of-life measure was 96.7, and the average single assessment numeric evaluation was 95.3. Radiographs at final follow-up showed no mortise widening or lateral talar subluxation. Two patients had mild degenerative changes on lateral radiographs with anterior tibial osteophytes.
In selective cases, athletes can return to full activity as early as 6 weeks after internal fixation of grade III syndesmosis sprains.

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    Article: Management of unstable ankle fractures and syndesmosis injuries in athletes.
    J Adam Jelinek, David A Porter
    [show abstract] [hide abstract]
    ABSTRACT: Athletes with unstable ankle injuries treated with rigid and anatomic internal fixation with concomitant repair of indicated ligaments followed by an accelerated rehabilitation program consisting of early weight bearing and near-immediate range of motion (ROM) can obtain excellent outcomes. Early ROM and weight bearing, if indicated depending on the specific injury pattern, can be effective with low morbidity. Return to sports can be expected as early as 4 weeks after rigid fixation of an isolated fibula fracture and up to 8 to 10 weeks after stabilization of a bimalleolar equivalent fracture with deltoid repair. Syndesmosis fixation can take up to 4 to 6 months before successful return to sport.
    Foot and ankle clinics 07/2009; 14(2):277-98.
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Keywords

4.5-mm cortical screw fixation
 
6 weeks
 
ankle problems
 
average clinical rating score
 
average follow-up
 
average quality-of-life measure
 
Case series
 
consecutive series
 
final follow-up
 
full activity
 
Grade III syndesmosis sprains
 
in-season sport activities
 
inclusion criteria
 
intercollegiate athletes
 
male intercollegiate college athletes
 
midterm follow-up
 
Outcome measures
 
rapid return
 
Sports Ankle Rating System
 
Sports Ankle Rating System scores
 

Dean C Taylor