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Functional Outcomes of Syndesmotic Injuries Based on Objective Reduction Accuracy at a Minimum 1-Year Follow-Up
Steven M Cherney1, Christopher T Cosgrove, Amanda G Spraggs-Hughes
1*Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR;†Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; and‡Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA.
Objective:
To evaluate whether objective syndesmosis reduction predicts functional outcomes and pain scores in patients with operatively treated syndesmotic injuries at a minimum 1-year follow-up.
Design:
Prospective Cohort.
Setting:
Urban Level I Trauma Center.
Patients:
Sixty-nine patients with operatively treated syndesmotic injuries were initially identified and consented for inclusion in the study. Nine patients were excluded perioperatively. Twelve patients were lost to follow-up. Forty-eight patients with operatively treated unilateral syndesmotic injuries were available and participated at the final follow-up.
Intervention:
Trans-syndesmotic stabilization with either 1 or 2 quadricortical position screws. Postoperatively, bilateral ankle computed tomography scans were obtained to objectively assess syndesmosis reduction accuracy.
Main Outcome Measurements:
Olerud-Molander Ankle Score, Short Musculoskeletal Function Assessment Dysfunction Index and Bother Index, and Numeric Pain Rating Scales at a minimum 1-year postoperative follow-up.
Results:
At 1-year follow-up, there was no significant difference in functional outcomes between reduced and malreduced groups at the 1.5-, 2-, and 3-mm thresholds for linear measurements. Similarly, there was no functional difference between the reduced and malreduced groups for rotational malreductions at a 10 or 15 degrees threshold. Patients with state-sponsored insurance (Medicaid) had significantly worse functional scores and pain scores when compared with the groups with private insurance, Medicare, or no insurance.
Conclusions:
At 1-year follow-up, functional outcomes were not related to objective measures of syndesmosis reduction.
Level Of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
