Ankle Syndesmosis Injuries

What is the syndesmosis?

The syndesmosis is the ligaments which stabilise the fibula and the tibia at the ankle joint.

They consist of the:

  • Anterior inferior tibiofibular ligament
  • Posterior inferior tibiofibular ligament
  • Interosseous ligament

When these ligaments get injured or torn this can result in increased movement between the tibia and fibula causing them to separate.

This can cause pain and if unrecognised can cause long term problems in the ankle joint with arthritis.

How does it get injured?

Often associated with a twisting injury to the ankle.

Can be caused when the foot is forced upward

It can be associated with a fracture of the fibula.

What are the symptoms?

Patients report pain in the front and outside of the ankle which is often felt higher up above the joint.

Pain persists after appropriate rehabilitation from a simple ankle sprain.

Swelling around the front and outside of the ankle.

Ankle Syndesmosis Injuries 1

What investigations are required?

Xrays can confirm if there is a separation between the bones in more severe injuries.

MRI can show there is a ligament injury but does not always confirm syndesmosis instability.

Weightbearing CT scan is useful to determine syndesmosis instability.

When is surgery considered?

Treatment is dependent on:

  • Extent of the ligament injury
  • Stability of the syndesmosis
  • Syndesmosis widening on xray = surgery
  • 1 ligament injury usually the anterior ligament
    • Physiotherapy
    • Activity modification
    • Most are better by 6-12 weeks
  • 2 or 3 ligaments injured
    • No syndesmosis instability- no surgery
    • Boot non weight bearing 6 weeks
    • Physiotherapy
    • By 3 months returning to recreational activities
    • Syndesmosis instability = surgery
  • Ongoing pain after non operative management- consider surgery

What does surgery involve?

Acute injury

  • Ankle arthroscopy
    • inspect the joint and syndesmosis,
    • remove any inflammation and scar tissue.
  • Tightrope fixation or screw fixation

Ankle Syndesmosis Injuries 2Chronic injury – >4 weeks

  • Open inspection and clearing of the syndesmosis
  • Tightrope fixation
  • Augmentation of the anterior inferior tibio-fibular ligament

What does the rehabilitation involve?

  • 1 night in hospital.
  • 2 weeks of elevation and rest in a cast non weightbearing.
  • You will be seen in Mr Curry’s rooms at 2 weeks where you see our Nurse Practitioner who will remove sutures and Mr Curry will guide you through your rehabilitation program.
  • 4 weeks in a Cam boot non weightbearing. Can undertake range of motion exercises.
  • Wean out of boot at 6 weeks from surgery and begin physiotherapy.
  • By 6 weeks managing daily activities.
  • By 3 months back to most recreational activities.
  • Swelling improves by 6- 9 months.
  • 6-9 months for final result.

How long will I be off work?

This is dependent upon your occupation

  • Seated job 2-3 weeks
  • Standing job 6-8 weeks
  • Heavy lifting job 10-12 weeks

When can I drive?

  • Manual car
    • No driving for 9 weeks
  • Automatic car
    • Left foot no driving for 2 weeks
    • Right foot no driving for 9 weeks

What are the risks of the procedure?

General risks of surgery

  • Infection
  • Wound healing problems
  • Nerve injury and scar sensitivity
  • Incomplete symptom resolution
  • Blood clots to the leg
  • Anaesthetic problems

Specific risks for syndesmosis surgery

  • Stiffness of the ankle due to scarring
  • Prominence of the tightrope requiring removal
  • Screws ( if used) require removal at 3 months
  • Recurrent instability of the syndesmosis if the fixation is removed ( rare )
This information is an overview of the management of syndesmosis injuries and is not all inclusive.

If you have any questions please contact Mr Curry’s rooms on (03) 99286560