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Published on: January 24, 2018
Return-to-Sport Outcomes After Suture Button Fixation for Syndesmotic Injury in Elite Athletes With Chronic Lateral
Cheng Wang1,2, Cheng Chen1,3, Shaoling Fu1,2
1National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China.
Background:
Chronic lateral ankle instability (CLAI) with concomitant syndesmotic injury presents a complex challenge for elite athletes. The arthroscopic modified Broström procedure (AMBP) is the gold-standard surgical treatment for CLAI, and suture button fixation (SBF) is an effective method for dynamically stabilizing the syndesmosis.
Purpose:
To evaluate functional outcomes and return-to-sport (RTS) metrics and identify prognostic factors after combined AMBP and SBF in this specific population.
Study Design:
Case series; Level of evidence, 4.
Methods:
A total of 70 elite athletes with CLAI and a confirmed syndesmotic injury who underwent AMBP and SBF between January 2021 and June 2023 were prospectively enrolled. Outcomes included the Foot and Ankle Outcome Score (FAOS), Karlsson-Peterson score, mean time to RTS, RTS rate, ankle range of motion (ROM), and complication rates. Weightbearing computed tomography was analyzed to measure anatomical parameters, including anterior, posterior, and maximum tibiofibular distances (ATFD, PTFD, maxTFD), angle of fibular rotation (AFR), and syndesmotic area (SA). Univariate and multivariate regression analyses identified factors associated with improvement in FAOS (Δ-FAOS).
Results:
A total of 68 patients (68 ankles [97.1%]), with a minimum 2-year follow-up, were included in our analysis. The mean time to unrestricted RTS was 53.2 ± 14.7 days, with a 98.5% (67/68) successful RTS rate. All FAOS subscales and the Karlsson-Peterson score demonstrated significant improvements from baselines (P < .001). Ankle ROM was restored to symmetry in all patients. One patient (1.5%) experienced transient superficial wound irritation. Univariate analysis indicated that Δ-FAOS was associated with sex, reduction in body mass index (BMI) (ΔBMI), duration of symptoms before surgery, and preoperative PTFD, maxTFD, AFR, and SA. Multivariate analysis confirmed that a greater reduction in BMI (P = .032; β = 1.8; [95% CI, 1.1-3.1]) and a smaller preoperative SA (P = .018; β = -0.7 [95% CI, 0.5-0.9]) were independent predictors of greater Δ-FAOS.
Conclusion:
Our study demonstrated that the combined AMBP and SBF procedure may facilitate rapid, successful RTS, with satisfactory patient-reported outcomes and a low complication rate among elite athletes. Preoperative SA and postoperative weight management (ΔBMI) may be significant prognostic factors for optimal clinical outcome.
