Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries

ABSTRACT Background Acute syndesmotic injuries were usually treated with trans-syndesmotic screw fixation. However, screw fixation is too strong compared with the physiologic ankle joint movement. In addition, it needs removal and leads to delayed rehabilitation. We propose the reconstruction of the anterior inferior tibiofibular ligament (AITFL) using suture anchors to substitute trans-syndesmotic screw fixation. Materials and methods We compared the results after trans-syndesmotic screw fixation and AITFL suture anchor fixation in syndesmotic injuries with or without ankle fracture. Consecutively, the trans-syndesmotic screw (group I) was conducted between June 2011 and June 2013, and since July 2013, suture anchor fixation was performed (group II). Reductions in quality, the American Orthopedic Foot and Ankle Society (AOFAS) score, and the Olerud–Molander ankle score (OMAS) were evaluated. Results The final AOFAS score and OMAS in both groups were not significantly different (p = 0.98, 0.67). Tibiofibular overlapping, tibiofibular space, and tibiofibular overlapping ratio to the tibial width in both groups had satisfactory reduction from the standards. Computed tomographic (CT) evaluation also confirmed that both groups had been anatomically reduced in standard. Anteroposterior axis reduction in CT was more accurate in group II. Nonclinically related complications were three broken screws in final follow-up in group I. Conclusion Both trans-syndesmotic screws and suture anchor fixation have satisfactory clinical outcomes. The suture anchor fixation for syndesmotic injury does not need removal and is less complicated compared with the trans-syndesmotic screw fixation. How to cite this article Kim JS. Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):57-62.

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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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