Decision-Making and Management of Acute Isolated Syndesmosis Injuries in Athletes

The ankle joint is one of the most frequently injured joints in the athletic population. Some articles estimate that it accounts for approximately 40% of all sports injuries, with lateral ankle sprains accounting for approximately 85% of injuries whereas medial ankle and syndesmosis injuries account for approximately 4-5% and 1-11%, respectively.^1-4 Incidence of ankle sprains has been reported to be as high as 7 per 1,000 exposures for court sports and 1 per 1,000 exposures for field sports with lateral ankle sprains being more common than medial or syndesmotic ankle inju-ries.⁵ While high ankle sprain, or syndesmosis injury, is less prevalent than lateral ankle sprain, it still accounts for a high injury burden. Among athletes from the National Collegiate Athletic Association (NCAA), the incidence of syndesmosis injury was found to be 1.00 per 10,000 athleteexposures, with men's football, wrestling and ice hockey having the highest rates of injury.³ Optimizing treatment of syndesmosis injury is important as they typically require a longer recovery period and have a high recurrence rate.^3,6,7 The purpose of this article is to review the pertinent anatomy and diagnostic features of syndesmosis injury, discuss the indications and goals of operative and non-operative management, and discuss return to play recommendations following these injuries.

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