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<p>Injuries of the distal tibiofibular syndesmosis complex are challenging to diagnose and treat. The complex, consisting of anterior (AiTFL), middle (interosseus ligament, IOL) and posterior ligament (PiTFL) parts, stabilizes the ankle joint in three planes. Isolated injuries occur in up to 30% of all distortions in athletes and in up to 20% of ankle fractures.</p><p>The greatest diagnostic challenge lies in distinguishing between stable 1‑ligament ruptures (AiTFL) and dynamically unstable 2‑ligament ruptures (AiTFL + IOL). This distinction seems to be possible only by means of dynamic imaging (stress ultrasound, image intensifier or digital volume tomography, DVT) in order to detect instability by comparing the sides. The authors recommend an anatomical classification based on the number of ruptured ligaments.</p><p>The surgical treatment should be arthroscopically assisted. The additive arthroscopy enables the verification of instability as well as the identification and treatment of accompanying intra-articular injuries. This is relevant as accompanying cartilage damage occurs in approximately 50% of cases and approximately 15% demonstrate loose bodies. Arthroscopy also enables assessment of the deltoid ligament complex and, to a&#xa0;limited extent, assessment of reduction.</p><p>Stable injuries can be treated conservatively. Unstable injuries should be treated surgically. The primary goal is anatomical reduction. The surgical strategy should be based on the extent of the injury. The authors treat 2‑ligament ruptures with a&#xa0;flexible cable pulley system or ventral augmentation. For 3‑ligament injuries, the authors use a&#xa0;combination of a&#xa0;flexible cable pulley system and a&#xa0;syndesmotic screw. Bilateral cross-sectional imaging (computed tomography, CT) should be performed to verify the postoperative reduction result.</p>

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Arthroskopie in der Versorgung von Syndesmosenverletzungen – State of the Art?

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Sebastian F. Baumbach,
  • Kiriakos Daniilidis,
  • Hans Polzer

摘要

Injuries of the distal tibiofibular syndesmosis complex are challenging to diagnose and treat. The complex, consisting of anterior (AiTFL), middle (interosseus ligament, IOL) and posterior ligament (PiTFL) parts, stabilizes the ankle joint in three planes. Isolated injuries occur in up to 30% of all distortions in athletes and in up to 20% of ankle fractures.

The greatest diagnostic challenge lies in distinguishing between stable 1‑ligament ruptures (AiTFL) and dynamically unstable 2‑ligament ruptures (AiTFL + IOL). This distinction seems to be possible only by means of dynamic imaging (stress ultrasound, image intensifier or digital volume tomography, DVT) in order to detect instability by comparing the sides. The authors recommend an anatomical classification based on the number of ruptured ligaments.

The surgical treatment should be arthroscopically assisted. The additive arthroscopy enables the verification of instability as well as the identification and treatment of accompanying intra-articular injuries. This is relevant as accompanying cartilage damage occurs in approximately 50% of cases and approximately 15% demonstrate loose bodies. Arthroscopy also enables assessment of the deltoid ligament complex and, to a limited extent, assessment of reduction.

Stable injuries can be treated conservatively. Unstable injuries should be treated surgically. The primary goal is anatomical reduction. The surgical strategy should be based on the extent of the injury. The authors treat 2‑ligament ruptures with a flexible cable pulley system or ventral augmentation. For 3‑ligament injuries, the authors use a combination of a flexible cable pulley system and a syndesmotic screw. Bilateral cross-sectional imaging (computed tomography, CT) should be performed to verify the postoperative reduction result.