Page 28 - ISAKOS 2020 Newsletter Volume 2

CURRENT CONCEPTS
Current Concepts in Managing Ankle Syndesmosis Injuries
The reported success of these aggressive postoperative rehabilitation protocols has generated an international conversation on whether prolonged immobilization, protected weight-bearing, and delayed return to sport is really necessary in all cases following surgical stabilization. The experience at this NCAA institution also has brought media attention and more public awareness to flexible device techniques. The ISAKOS LAF survey suggests that there is substantial variability in return-to-sport protocols, although the mean values of survey responses and those in in D’Hooghe et al.’s study are strikingly similar.
Conclusion
Syndesmotic injuries are very common in field and court sports. Injury severity, nuanced diagnosis, and long-term functional risk have led to significant advances in diagnosis and management protocols. Indeed, our approach to these injuries has changed considerably, even in the last decade. While there is an ongoing need for additional science to support new surgical stabilization constructs and accelerated return-to-sport protocols, the current management ethos has evolved toward flexible-fixation-device constructs and accelerated return-to-sport protocols. Perhaps the most valuable tools to inform our understanding of the results of evolving treatment strategies are sports registries such as that described by D’Hooghe et al. Such registries, when inclusive of critical data elements classifying injury and specifying treatment, have immense real-world value in guiding treatment protocols for athletes. The ISAKOS LAF committee has envisioned an international collaboration of registries and institutional datasets to help us understand current treatment outcomes. Until data from such collaboration are broadly available, we rely on reports of outcomes from a rapidly evolving treatment landscape.
References
1. Lubberts B, D’Hooghe P, Bengtsson H, DiGiovanni CW, Calder J, Ekstrand J. Epidemiology and return to play following isolated syndesmotic injuries of the ankle: a prospective cohort study of 3677 male professional footballers in the UEFA Elite Club Injury Study. Br J Sports Med. 2019;53(15):959-964. 2. van Dijk CN, Longo UG, Loppini M, et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2016;24(4):1200-1216. 3. Soin SP, Knight TA, Dinah AF, Mears SC, Swierstra BA, Belkoff SM. Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison. Foot & ankle international. 2009;30(4):346-352. 4. Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials. The American journal of sports medicine. 2018:363546518804804. 5. D’Hooghe P, Grassi A, Alkhelaifi K, et al. Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study. Br J Sports Med. 2019.
26 ISAKOS NEWSLETTER 2020: VOLUME II