Summary

The literature to date indicates that when a pure lesion of the syndesmosis is suspected, arthroscopy is recommended to evaluate the syndesmosis and confirm the diagnosis of instability. Based on the classification proposed to determine the degree of instability according to the ligaments involved by MRI, we believe that it can be inferred and correlated with the instability found by arthroscopy.

Abstract

Purpose

The term "pure syndesmosis" is commonly used for injuries of the syndesmotic complex without ankle fractures, although it may present withligamentous injuries or tibiofibular avulsion fractures or tibiofibular avulsion fractures. Early diagnosis with appropriate treatment is mandatory to avoid the development of scar tissue impingement, chronic instability or formation of heterotopic ossification or deformity of the ankle joint.
The aim of the present study is to corroborate the finding found in all those patients operated arthroscopically for a pure syndesmotic lesion and the anatomical correlation with the degree of proposed instability diagnosed by MRI.

Methods

This was a retrospective observational study, in which 16 patients, operated on between 2018 and 2023, were included. All patients with suspected instability due to pure syndesmotic lesion, who had undergone diagnostic arthroscopy, and who presented in their clinical history records a preoperative MRI study to corroborate the proposed algorithm of instability with the findings found in the procedure were included.

Results

Sixteen patients were operated on (13 males and 3 females). All presented instability criteria in our MRI classification, and all were corroborated in the diagnostic arthroscopy. All required syndesmosis repair, which was performed using a minimally invasive technique with a button system. In addition, all 16 patients also required an arthroscopic All-Inside Anterior Talofibular Ligament Repair, and only 3 patients also required
arthroscopic repair of the deltoid ligament. All reported improved pain and were satisfied with the procedure. None developed joint instability again until the end of the study. There were no major complications, only 3 high-performance athlete patients required removal of the syndesmosis button after some time.

Conclusion

The literature to date indicates that when a pure syndesmosis lesion is suspected, it is recommended to perform a fluoroscopic examination with the patient under anesthesia and, if necessary, an arthroscopy to evaluate the syndesmosis and confirm the diagnosis. Therefore, we believe that this classification and treatment algorithm, based on MRI diagnosis, can provide the appropriate orthopedic or surgical treatment
according to the suspected instability in order to avoid complications due to diagnostic procedures or underdiagnosed lesions. A prospective comparative study would be necessary to determine and evaluate this algorithm.