Syndesmotic reduction: What technique is most accurate?

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomechanics

Background:

• Syndesmotic injuries often require accurate reduction for optimal outcomes.
• Current reduction methods vary in reliability, particularly with increasing injury severity.

Purpose of the Study:

• To compare the reliability of three syndesmotic reduction methods: indirect clamp reduction, direct reduction with incisura palpation, and direct reduction with articular surface visualization.
• To evaluate these methods across different syndesmotic injury severities (ventral disruption, 2-ligament, and 3-ligament injuries).

Main Methods:

• Utilized a cadaveric model with eight knee specimens.
• Induction of various syndesmotic injuries.
• Assessment of sagittal plane translation using a digital caliper post-reduction.
• Malreduction defined as >2mm difference from the intact state.

Main Results:

• Direct reduction with articular surface visualization demonstrated the highest accuracy across all injury types (p > 0.01).
• Indirect clamp reduction was the least reliable, showing the highest malreduction rates (p = 0.585).
• Direct reduction with incisura palpation was reliable for 2 and 3-ligament injuries (p = 0.518), but malreduction increased with injury severity.

Conclusions:

• Direct visualization of the articular surface is the most accurate and reliable method for syndesmotic reduction.
• The historically used indirect clamp reduction method is unreliable and associated with a high incidence of malreduction.
• Surgeons should consider the subjectivity and limitations of clamp reduction, favoring direct visualization for improved accuracy.