Chronic Syndesmotic Injuries: Arthrodesis versus Reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Anatomy

Background:

• Chronic syndesmotic injuries present diverse symptoms and pathologies.
• Ankle syndesmotic injuries can lead to instability and pain, affecting function.
• Timely and appropriate treatment is essential for optimal outcomes.

Purpose of the Study:

• To review and categorize treatment strategies for chronic syndesmotic injuries.
• To provide guidance on surgical interventions based on injury severity and patient factors.
• To emphasize the importance of addressing malunions for ankle mortise congruency.

Main Methods:

• Review of current literature and established treatment algorithms for syndesmotic injuries.
• Categorization of treatments based on injury chronicity, stability, and specific pathologies.
• Discussion of surgical techniques including arthroscopic debridement, ligamentoplasty, screw fixation, and tibiofibular fusion.

Main Results:

• Anterolateral impingement without instability treated with arthroscopic debridement.
• Subacute unstable injuries managed with debridement and stabilization (suture button or screw).
• Chronic instability addressed by ligamentoplasty with screw fixation or tibiofibular fusion for poor bone stock or failed reconstructions.
• Correction of malleolar malunions and syndesmotic avulsions is vital.

Conclusions:

• Treatment selection for chronic syndesmotic injuries depends on specific clinical presentation and patient factors.
• Surgical interventions aim to restore ankle stability and congruency.
• Addressing bony malalignments and avulsions is critical for successful long-term outcomes.