Flexible Triple Fixation for Chronic Syndesmotic Instability: A Technical Tip.

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Chronic syndesmotic instability disrupts normal ankle biomechanics and load distribution, potentially leading to degenerative arthritis.
• Current treatment options for chronic tibiofibular instability may not fully address residual instability.

Purpose of the Study:

• To describe a novel triple-fixation technique for treating chronic tibiofibular instability.
• To evaluate the efficacy of this construct in a small cohort of patients.

Main Methods:

• A triple-fixation technique combining a suture button and FiberTape was utilized.
• Case review of 3 patients (aged 22, 25, 53) with chronic syndesmotic instability and distal tibiofibular joint incongruence.

Main Results:

• All patients achieved a postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score of 100, a significant improvement from preoperative scores (54-77).
• Mean follow-up periods ranged from 11 to 17 months.
• One patient experienced mild discomfort at the suture-button site; no other complications were reported.

Conclusions:

• The triple-fixation technique demonstrated effectiveness in stabilizing chronic syndesmotic injuries.
• This construct offers a viable option for managing residual instability in chronic distal tibiofibular joint lesions.
• Limitations include the technical-tip nature, small sample size, and short follow-up.