Suture-Button Fixation and Mini-Open Anterior Inferior Tibiofibular Ligament Augmentation Using Suture Tape for Tibiofibular Syndesmosis Injuries

Aims The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. Methods Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)). Results All patients returned to their pre-injury level of sports activities. One patient developed a delayed union of the medial malleolus. The mean return to play was 62 days (49 to 84) for isolated injuries, while the patients with concomitant injuries returned to play in a mean of 104 days (56 to 196). The AOFAS score returned to 100 postoperatively in all patients. Knee-to-wall measurements were the same as the contralateral side in 18 patients, while one patient lacked 2 cm compared to the contralateral side. Conclusion This study suggests the use of the InternalBrace in the management of unstable syndesmotic injuries offers an alternative method of stabilization, with good short-term results, including early return to sports in elite athletes. Cite this article: Bone Joint J 2022;104-B(1):68–75.

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Anterior inferior tibiofibular ligament augmentation for syndesmosis injury: A cadaveric study

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.347 ◽

2017 ◽

Vol 23 ◽

pp. 85-86

Author(s):

H. Shoji ◽

A. Teramoto ◽

D. Suzuki ◽

Y. Okada ◽

Y. Sakakibara ◽

...

Keyword(s):

Cadaveric Study ◽

Tibiofibular Ligament ◽

Syndesmosis Injury ◽

Ligament Augmentation ◽

Anterior Inferior Tibiofibular Ligament

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Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-010-1311-1 ◽

2010 ◽

Vol 19 (4) ◽

pp. 691-695 ◽

Cited By ~ 44

Author(s):

Youichi Yasui ◽

Masato Takao ◽

Wataru Miyamoto ◽

Ken Innami ◽

Takashi Matsushita

Keyword(s):

Anatomical Reconstruction ◽

Tibiofibular Syndesmosis ◽

Tibiofibular Ligament ◽

Distal Tibiofibular Syndesmosis ◽

Anterior Inferior Tibiofibular Ligament

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Anterior Syndesmotic Augmentation Technique Using Nonabsorbable Suture-Tape for Acute and Chronic Syndesmotic Instability

Foot & Ankle International ◽

10.1177/1071100720951172 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1307-1315

Author(s):

John Y. Kwon ◽

Derek Stenquist ◽

Michael Ye ◽

Caroline Williams ◽

Eric Giza ◽

...

Keyword(s):

Expert Opinion ◽

Current Work ◽

Level Of Evidence ◽

Operative Strategy ◽

Nonabsorbable Suture ◽

Preliminary Results ◽

Patient Cohort ◽

Tibiofibular Ligament ◽

Anterior Inferior Tibiofibular Ligament ◽

Suture Tape

Syndesmotic instability is a source of significant pain and disability. Both subtle instability and gross diastasis, whether acute or chronic, require stabilization and may benefit from reconstruction with ligamentous augmentation. The use of nonabsorbable suture-tape has emerged as a promising operative strategy, allowing surgeons to anatomically reconstruct the syndesmosis, in particular the anterior inferior tibiofibular ligament. The current work provides a detailed description of the technique and preliminary results of a patient cohort treated using nonabsorbable suture-tape for syndesmotic augmentation. Level of Evidence: Level V, expert opinion.

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The Effect of Varying Tension of a Suture Button Construct in Fixation of the Tibiofibular Syndesmosis—Evaluation Using Stress Computed Tomography

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000737 ◽

2017 ◽

Vol 31 (2) ◽

pp. 103-110 ◽

Cited By ~ 4

Author(s):

John Morellato ◽

Hakim Louati ◽

Andrew Bodrogi ◽

Andrew Stewart ◽

Steven Papp ◽

...

Keyword(s):

Computed Tomography ◽

Tibiofibular Syndesmosis ◽

Suture Button

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The Clinical Efficacy of Suture-button Fixation and Trans-syndesmotic Screw Fixation in the Treatment of Ankle Fracture Combined with Distal Tibiofibular Syndesmosis Injury: A Retrospective Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2021.07.009 ◽

2021 ◽

Author(s):

Yibo Xu ◽

Ran Kang ◽

Ming Li ◽

Zhong Li ◽

Teng Ma ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Efficacy ◽

Ankle Fracture ◽

Screw Fixation ◽

Tibiofibular Syndesmosis ◽

Suture Button ◽

Syndesmotic Screw ◽

Distal Tibiofibular Syndesmosis ◽

Syndesmosis Injury

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Impact of Torque on Assessment of Syndesmotic Injuries Using Weightbearing Computed Tomography Scans

Foot & Ankle International ◽

10.1177/1071100719829720 ◽

2019 ◽

Vol 40 (6) ◽

pp. 710-719 ◽

Cited By ~ 10

Author(s):

Nicola Krähenbühl ◽

Travis L. Bailey ◽

Maxwell W. Weinberg ◽

Nathan P. Davidson ◽

Beat Hintermann ◽

...

Keyword(s):

Computed Tomography ◽

Axial Load ◽

External Rotation ◽

Ct Scans ◽

Deltoid Ligament ◽

Tibiofibular Syndesmosis ◽

Tibiofibular Ligament ◽

Distal Tibiofibular Syndesmosis ◽

Axial Ct ◽

The Impact

Background: The diagnosis of subtle injuries to the distal tibiofibular syndesmosis remains elusive. Conventional radiographs miss a large subset of injuries that present without frank diastasis. This study evaluated the impact of torque application on the assessment of syndesmotic injuries when using weightbearing computed tomography (CT) scans. Methods: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kg) and with (10 Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during 4 test conditions. First, intact ankles (native) were scanned. Second, 1 specimen from each pair underwent anterior inferior tibiofibular ligament (AITFL) transection (condition 1A), while the contralateral underwent deltoid transection (condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact deltoid or AITFL was transected (condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (condition 3). Measurements were performed to assess the integrity of the distal tibiofibular syndesmosis on digitally reconstructed radiographs (DRRs) and on axial CT scans. Results: Torque impacted DRR and axial CT scan measurements in almost all conditions. The ability to diagnose syndesmotic injuries using axial CT measurements improved when torque was applied. No significant syndesmotic morphological change was observed with or without torque for either isolated AITFL or deltoid ligament transection. Discussion: Torque application had a notable impact on two-dimensional (2-D) measurements used to diagnose syndesmotic injuries for both DRRs and axial CT scans. Because weightbearing conditions allow for standardized positioning of the foot while radiographs or CT scans are taken, the combination of axial load and torque application may be desirable. Clinical Relevance: Application of torque to the tibia impacts 2-D measurements and may be useful when diagnosing syndesmotic injuries by DRRs or axial CT images.

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Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

Journal of International Medical Research ◽

10.1177/0300060519882550 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051988255

Author(s):

Kee Jeong Bae ◽

Seung-Baik Kang ◽

Jihyeung Kim ◽

Jaewoo Lee ◽

Tae Won Go

Keyword(s):

Fracture Fixation ◽

Ankle Fracture ◽

Avulsion Fracture ◽

Screw Fixation ◽

Malleolar Fracture ◽

Tibiofibular Ligament ◽

Radiographic Parameters ◽

Syndesmotic Screw ◽

Anterior Inferior Tibiofibular Ligament ◽

American Orthopaedic

Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.

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