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Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Correct management of syndesmotic injuries is mandatory to avoid scar tissue impingement, chronic instability, heterotopic ossification, or deformity of the ankle. The aim of the present study was to perform a systematic review of the current treatments of these injuries to identify the best non-surgical and surgical management for patients with acute isolated syndesmotic injuries.

Methods

A review of the literature was performed according to the PRISMA guidelines. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed using the following keywords: “ankle injury”, “syndesmotic injury”, “chronic”, “acute”, “treatment”, “conservative”, “non-operative” “operative”, “fixation”, “osteosynthesis”, “screw”, “synostosis”, “ligamentoplasties” over the years 1962–2015.

Results

The literature search and cross-referencing resulted in a total of 345 references, of which 283 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included four studies, describing non-surgical management, and only two studies investigating surgical management of acute isolated injuries.

Conclusions

The ESSKA-AFAS consensus panel provided recommendations to improve the management of patients with isolated acute syndesmotic injury in clinical practice. Non-surgical management is recommended for stable ankle lesions and includes: 3-week non-weight bearing, a below-the-knee cast, rest and ice, followed by proprioceptive exercises. Surgery is recommended for unstable lesions. Syndesmotic screw is recommended to achieve a temporary fixation of the mortise. Suture-button device can be considered a viable alternative to a positioning screw. Partial weight bearing is allowed 6 weeks after surgery.

Level of evidence

IV.

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Acknowledgments

We like to thank the following members of the ESSKA-AFAS consensus committee for their contribution: Gino Kerkhoffs, James Calder, John Kennedy, Akos Kynsburg, Tahir Ogut, Beat Hintermann, Milan Handl, Pietro Spennacchio.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands

    C. Niek van Dijk

  2. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy

    Umile Giuseppe Longo, Pino Florio, Ludovica Maltese, Mauro Ciuffreda & Vincenzo Denaro

  3. Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy

    Mattia Loppini

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  1. C. Niek van Dijk
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Correspondence to Umile Giuseppe Longo.

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van Dijk, C.N., Longo, U.G., Loppini, M. et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 24, 1217–1227 (2016). https://doi.org/10.1007/s00167-016-4017-1

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