Delayed stabilisation of dynamically unstable syndesmotic injuries results in worse functional outcomes
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ANKLE
Delayed stabilisation of dynamically unstable syndesmotic injuries results in worse functional outcomes Steven Kent1,5 · Gerald Yeo2 · Daniel Marsland3 · Matthew Randell1 · Benjamin Forster1 · Michael Lutz1 · Satomi Okano4 Received: 19 November 2019 / Accepted: 23 March 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function. Method A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010–2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury ( 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS). Results Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended. Level of evidence Level III. Keywords Ankle · Syndesmosis fixation · Sprain · Diastasis · Ligaments · Arthroscopy · Chronic · FAOS · Function
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-05962-1) contains supplementary material, which is available to authorized users. * Steven Kent [email protected] 1
Mater Hospital, Brisbane, QLD, Australia
2
Prince Charles Hospital, Brisbane, QLD, Australia
3
Royal Hampshire County Hospital, Hampshire, UK
4
Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
5
Department of Orthopaedic Surgery, Mater Adults Hospital, Raymond Terrace, South Brisbane, QLD 4101, Australia
High ankle sprains comprise up to 12% of all ankle sprains [27], but have also been shown to make up 25% of ankle sprains in collision sports [10, 11, 29]. Syndesmosis injuries of the ankle are less common than acute lateral ligament injuries, but they are often difficult to diagnose accurately and are associated with a less predictable outcome and a prolonged recovery [10, 19, 30]. Controversy in management of high ankle sprains has arisen regarding the treatment of West Point Grade II sprains [10], due to difficulty in identifying those patients suffering dynamic instability. Patients with dynamic instability may re
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