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Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective.

Publication ,  Journal Article
Hunt, KJ; Bartolomei, J; Challa, SC; McCormick, JJ; D'Hooghe, P; Tuffiash, M; Amendola, A; ISAKOS Leg, Ankle Foot Committee
Published in: J ISAKOS
February 2022

OBJECTIVES: Although the body of literature on syndesmosis injuries is growing with regard to both the biomechanics and clinical outcomes for various fixation constructs, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavoured to assess the current approaches to managing syndesmotic injuries through a Research Electronic Data Capture survey. METHODS: The survey consisted of 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment and technique, and postoperative management. Responses were generated through six different athlete scenarios: moderate impact, high impact, and very high impact athletes with/without complete deltoid injury. Frequencies and percentages were calculated for all categorical responses. RESULTS: A total of 742 providers responded to the survey, including 457 American surgeons and 285 members of various international societies. Flexible devices were the preferred fixation construct (47.1%), followed by screws (29.6%), hybrid fixation (e.g. combination of flexible device and screw, 18%), and other (5.3%). Sixty-four percent of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated return to full participation, largely dependent on the presence or absence of a deltoid ligament injury. CONCLUSION: The most common elements used as surgical indications were syndesmosis widening > 2 mm on x-ray, an anterior inferior talofibular ligament injury in combination with a posterior inferior talofinular ligament or deltoid ligament involvement on magnetic resonance imaging, and widening of the distal tibiofibular joint during arthroscopic evaluation. Overall, flexible fixation (e.g. suture button) was the preferred device choice for the repair of an injured syndesmosis. Most respondents did not alter their rehab protocol or anticipated return to play timeline based on the injury severity. However, there was considerable variability between respondents on the time to weight-bearing, running, and full participation. Further pragmatic outcomes data are necessary to guide safe return to play protocols for syndesmotic injuries. LEVEL OF EVIDENCE: Level IV.

Duke Scholars

Published In

J ISAKOS

DOI

EISSN

2059-7762

Publication Date

February 2022

Volume

7

Issue

1

Start / End Page

13 / 18

Location

England

Related Subject Headings

  • United States
  • Return to Sport
  • Lateral Ligament, Ankle
  • Humans
  • Bone Screws
  • Ankle Joint
  • Ankle Injuries
 

Citation

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Chicago
ICMJE
MLA
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Hunt, K. J., Bartolomei, J., Challa, S. C., McCormick, J. J., D’Hooghe, P., Tuffiash, M., … ISAKOS Leg, Ankle Foot Committee. (2022). Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective. J ISAKOS, 7(1), 13–18. https://doi.org/10.1016/j.jisako.2021.10.005
Hunt, Kenneth J., Jonathan Bartolomei, Shanthan C. Challa, Jeremy J. McCormick, Pieter D’Hooghe, Michael Tuffiash, Annunziato Amendola, and ISAKOS Leg, Ankle Foot Committee. “Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective.J ISAKOS 7, no. 1 (February 2022): 13–18. https://doi.org/10.1016/j.jisako.2021.10.005.
Hunt KJ, Bartolomei J, Challa SC, McCormick JJ, D’Hooghe P, Tuffiash M, et al. Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective. J ISAKOS. 2022 Feb;7(1):13–8.
Hunt, Kenneth J., et al. “Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective.J ISAKOS, vol. 7, no. 1, Feb. 2022, pp. 13–18. Pubmed, doi:10.1016/j.jisako.2021.10.005.
Hunt KJ, Bartolomei J, Challa SC, McCormick JJ, D’Hooghe P, Tuffiash M, Amendola A, ISAKOS Leg, Ankle Foot Committee. Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective. J ISAKOS. 2022 Feb;7(1):13–18.

Published In

J ISAKOS

DOI

EISSN

2059-7762

Publication Date

February 2022

Volume

7

Issue

1

Start / End Page

13 / 18

Location

England

Related Subject Headings

  • United States
  • Return to Sport
  • Lateral Ligament, Ankle
  • Humans
  • Bone Screws
  • Ankle Joint
  • Ankle Injuries