Syndesmosis injury and instability
Injuries to this critical ankle ligament occur in turf sports and are sometimes missed at first
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The syndesmosis is a ligament that holds the tibia and fibula in precise alignment with each other. This alignment is critical for the function of the ankle joint. Approximately 5 to 15% of ankle sprains lead to injury of the syndesmosis. Fresh injuries respond to careful immobilization and gradual return to weight-bearing. If the diagnosis is missed or delayed, severe and sometimes permanent ankle damage can occur. Surgical repair of the syndesmosis may prevent the damage.
The syndesmosis is the strong but flexible attachment between the tibia and fibula which is critical for ankle joint alignment and function. High ankle sprain is a synonym for injury of this ligament. Syndesmosis injury occurs in approximately 5 to 15% of ankle sprains, and in ankle fractures where the fibula is fractured well above the ankle joint level. There is an increased risk of this injury in hockey, football, and skiing, as well as in elite or high-performance athletes. The most common mechanism is an external rotation force. The diagnosis may be missed or delayed, causing significant disability and the possibility of long-term damage. Clinical findings include pain in the anterior lateral ligament area and persistent pain following ankle sprain. The external rotational stress test and the squeeze test are positive. X-rays may be normal, or may show a small avulsion fragment. MRI alone is not sufficient to make the diagnosis. Special stress x-rays will show the injury. The critical finding is the disruption of the precise measurable relationship between the tibia and fibula, with widening of the normal distances. Fresh injuries without x-ray abnormalities may be treated by careful and prolonged immobilization, often in a cast. Injuries discovered late or with abnormal findings on x-rays benefit from surgery. New minimally invasive and outpatient surgical techniques are available to treat this condition. These techniques may allow the patient to resume weight-bearing immediately. The goal of treatment is to restore the relationship between the tibia and the fibula, and hold the two bones in appropriate alignment until healing is complete. more>>
Syndesmosis injuries are sometimes missed or treatment is not sufficient to restore the normal anatomy and function. This can lead to persistant pain after an ankle sprain, slow return to sports, or inability to return to sports after an ankle injury. In these cases, a careful history and physicial examination and high-quality xrays as well as special dynamic xrays will reveal the problem and lead to prompt and effective treatmentmore>>
See also: Sports Ankle Achilles Foot and ankle Home Appointments Send Message