Outcomes and Complications Following Treatment of Chronic Subtle Syndemotic Injury with Arthroscopic Debridement and Fixation with Suture Button

Abstract

Category: Ankle; Arthroscopy Introduction/Purpose: The syndesmotic injury can be occurred 10-18 percent associated with acute ankle sprain. This injury is commonly missed due to a difficulty to diagnosis in acute setting leading to chronic pain, swelling, and inability to return to previous level of activities and sports. Anterior ankle arthroscopic examination has been proposed to be successful technique to establish the diagnosis of this subtle injury. The purpose of this study is to demonstrate outcomes and complications of the patients who isolated syndesmotic injury and treated with anterior ankle arthroscopic debridement and fixation with suture button. Methods: A prospective case series of 62 patients who had ankle sprain with chronic pain on syndesmosis between 2015 and 2019 were enrolled in this study. All patients were failed from conservative treatment including bracing, ankle range of motion and strengthening exercises, low-does laser, and ultrasound treatment for at least 6 months after initial injury. The syndesmotic injury was considered when patients had chronic pain and swelling and athletic taping test was positive, and MRI demonstrated AITFL torn or fluid was ascended more than 10mm from ankle joint line. All patients were confirmed by intra-operatively ankle arthroscopy with a 3-mm shaver could pass through the syndesmotic joint. Syndesmotic joint was debridement and was fixed by suture button. Pre- and post-operative SF-36, FAAM, and VAS were obtained and compared using a paired t-test. Operative times, complications, and recovery times including time to return to ADL, work, and sports were recorded. Results: There were significant improvements of all functional outcomes (FAAM, SF-36, and VAS (p < 0.001 all)) with an average follow-up of 20.8 months. An average operative time was 30.2 minutes. Patients reported no previous pain after the operation (VAS 0/10, 54/62) and mild pain (VAS 1-2/10, 8/62). There were 6 patients with osteochondral injury intraoperatively and 9 patients with enlargement of anteroinferior tibiofibular ligament (AITFL). Recovery times included returned to ADL 4.9 weeks, to work 6.8 weeks, and to sports 5.8 months. Four patients had saphenous nerve irritation from the medial button and this was fully recovery at 4.8 months post-operatively and 2 patients has mild pain on fibular. There were no migration or disruption of suture button and no wound complications. Conclusion: Isolated sublte syndesmotic injury after ankle injury was successfully confirmed by anterior ankle arthroscopic examination and arthroscopic debridement and suture button fixation demonstrated significant improvement of functional outcomes as measured with FAAM, SF-36, and VAS. and patients were able to return previous activities. This technique is effective, safe, and feasible for treatment in patients with isolated subtle syndesmotic injury.