Insights into isolated syndesmotic injuries Arthroscopic assessment and treatment outcomes

Isolated injuries of the distal tibiofibular joint are either stable or unstable. Syndesmotic instability is a condition of extensive multiplanar fibular motion relative to the tibia. We found that the incidence of isolated syndesmotic injuries in elite professional European soccer increased annually between 2001 and 2016. Most of these injuries were caused during tackles.
Misdiagnosed unstable injuries can lead to inadequate conservative treatment, causing prolonged time to return to play and degenerative changes of the ankle joint over time. Ankle arthroscopy is the most reliable tool for assessing the degree of stability of the syndesmosis. Our results indicate that this assessment should be performed without ankle distraction. Based on arthroscopically measured multiplanar fibular motion, the recently developed ASA tool -described in the thesis- is a first step to quantify stable and unstable injuries. The long-term usefulness of the ASA tool, however, depends on whether an unstable syndesmosis correlates with clinical symptoms. This is topic of future investigations.
We found that neither screw nor suture button fixations optimally stabilize the syndesmosis. Future research should also investigate the natural history of stable and unstable injuries. How do isolated injuries develop without treatment? These investigations should take into account the heterogeneity among patients (younger vs. older patients, athletes vs. non-athletes, obese vs. non-obese). Only if these issues are addressed first it will be possible for clinicians and researchers to adequate assess new treatment strategies and their related outcomes.