Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints

doi:10.1016/S0749-8063(05)80014-3

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 10, Issue 5, October 1994, Pages 558-560

https://doi.org/10.1016/S0749-8063(05)80014-3 Get rights and content

Summary

We investigated the relative importance to stability of the four component ligaments of the distal tibiofibular syndesmosis. Eight fresh-frozen cadaver specimens were tested on a hydraulic test system during sequential cutting of the ligaments. The percentage resistance to 2 mm of diastasis was measured for the four ligaments. The anterior inferior tibiofibular ligament provided 35%, interosseous ligament 22%, superficial posterior inferior tibiofibular 9%, and deep posterior inferior tibiofibular 33%. These results have clinical implications with regard to injury. Damage to the syndesmosis should be assessed anteriorly and posteriorly at the time of examination. The interosseous ligament can be visualized arthroscopically.

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Cited by (244)

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Treatment of posterior malleolar fracture with plate or screw fixation is still controversial. Plate fixation is considered to have better stability but more soft tissue damage; screw fixation is less invasive and may yields lesser blood loss and surgery time. We conducted this meta-analysis to explore intraoperative and postoperative efficacy between plate and screw fixation in posterior malleolar fractured patients.
PubMed, Cochrane, Embase, Scopus and Chinese National Knowledge Infrastructure databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals was used. The outcomes of interest were surgery time, blood loss, length of hospital stay, American Orthopedic Foot and Ankle Score (AOFAS), bone healing time, full weight bearing time, off bed ambulation time, Visual Analogue Scale (VAS), complication rate, and rate of use of syndesmosis screw etc.
One randomized clinical trial and fifty-two retrospective cohort studies with a total of 3757 patients (1956 in screw group and 1801 in plate group) were included in the systematic review. Compared to screw group, plate group yielded significantly longer surgery time, more intraoperative blood loss, but shorter length of hospital stay, better AOFAS, better Baird Jackson score, better AOFAS and Baird Jackson excellent-good rate, shorter bone healing time, shorter time enabling full weight bearing, shorter time enabling off bed ambulation, lesser postoperative pain, lesser complication rate, lesser loosening rate, lesser malunion rate, and lesser postoperative osteoarthritis.
Plate fixation is a favorable alternative to screw fixation in posterior malleolar fractured patients. Although plate fixation was at risk of longer surgery time and more blood loss, it provided better postoperative functional outcome, shorter healing, weight bearing and off bed ambulation time and lesser pain compared to screw fixation.
Chronic syndesmotic instability – Current evidence on management
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This review article discusses the current evidence on the management of chronic syndesmotic instability. Conservative treatment has a limited role, and surgical intervention is most commonly reported as the mainstay of treatment, however the literature consists of small case series and descriptions of operative techniques, and thus the evidence base for any treatment is weak. Surgical options include arthroscopic debridement alone, static fixation with cortical screws, dynamic fixation with suture-button devices, and ligamentous repair or augmentation.
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Difference in Joint Stability Between Small Posterior Malleolar Fragments With Fixation and Those Without Fixation: A Biomechanical Cadaver Study
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The indication for the surgical treatment of ankle fractures that involve a posterior malleolar fragment remains controversial. This cadaver study assessed the biomechanical results of rotation stiffness of Haraguchi type 1 posterior malleolar fragments with or without cannulated screw fixation. Twelve anatomic lower-extremity specimens from 6 cadavers were tested. Six right legs were subjected to posterior malleolus osteotomy (Haraguchi type I) followed with (group A; n = 3) or without (group B; n = 3) fixation using a cannulated screw. Ankle joint stability was measured under both external rotation force and axial loading, and the passive resistive torque was measured in both groups. The mean torque value in group A was 0.1093 Nm/º, while that in group B was 0.0537 Nm/º. There was a significant intergroup difference (p = .004). In group B, the torque value was further increased in the latter rotation period (about 40-60 degrees). Group A proved more stable under experimental conditions than group B. Fixation in type I posterior malleolar fragments produced improved stability in ankle rotation, even for posterior malleolar fragments involving <25% of the articular surface, and has been considered an effective aid in treatment.

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^*: This paper was awarded the Richard O'Connor Prize of the Arthroscopy Association of North America.

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Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints*

Summary

Arthroscopy

Anatomy of the foot and ankle

Dynamic fibular function

Clin Orthop

The ankle

Syndesmotic ankle sprains

Am J Sports Med