Ankle Syndesmotic Injury With Posterior Tibial Tendon Rupture

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Anatomy

Background:

• Isolated ankle syndesmotic injuries, often associated with athletic activities, are typically diagnosed as high ankle sprains.
• Concomitant rupture of the posterior tibial tendon alongside syndesmotic instability is an exceptionally rare occurrence.
• Fracture absence in syndesmotic injuries necessitates a thorough evaluation for associated soft-tissue damage.

Purpose of the Study:

• To emphasize the importance of suspecting associated soft-tissue pathology in cases of syndesmotic instability without fracture.
• To highlight the diagnostic challenges and management strategies for a rare injury pattern involving syndesmotic rupture and posterior tibial tendon tear.
• To advocate for prompt clinical and imaging assessment and surgical intervention for identified tendon ruptures.

Main Methods:

• Case report detailing a patient with isolated ankle syndesmotic injury and concomitant posterior tibial tendon rupture.
• Review of clinical presentation, diagnostic imaging findings (e.g., MRI, X-ray), and surgical intervention.
• Discussion of the biomechanical implications and treatment outcomes for this specific injury pattern.

Main Results:

• The case illustrates a rare presentation of syndesmotic instability without associated fracture, complicated by posterior tibial tendon rupture.
• Comprehensive evaluation revealed the extent of soft-tissue injury, necessitating surgical management.
• Primary tendon repair was performed, addressing both the syndesmotic disruption and the tendon tear.

Conclusions:

• A high index of suspicion for associated soft-tissue injuries, such as posterior tibial tendon rupture, is critical in patients with syndesmotic instability, even without radiographic evidence of fracture.
• Thorough clinical examination and advanced imaging are essential for accurate diagnosis of isolated syndesmotic injuries.
• Primary repair of the posterior tibial tendon is supported as an effective treatment when rupture is identified in conjunction with syndesmotic injury.