Tibiofibular Syndesmosis Injury

Syndesmotic injuries or “high ankle” sprains are reported in 20% of athletes after an acute ankle sprain and are correlated with prolonged pain, dysfunction, and return to sports. Recent epidemiological data suggest an increasing incidence of isolated injuries related to more competitive football gameplay and a steady burden over the last 15 years. Two main injury mechanisms are associated with syndesmotic lesions: (1) forceful external rotation of the foot during ankle dorsiflexion and foot pronation and (2) ankle hyper-dorsiflexion. Arthroscopy is the current diagnostic standard for tibiofibular syndesmosis injury. Instability and diastasis can be evaluated under arthroscopic visualization with complete accuracy, especially for treatment decisions for dynamic instabilities. The literature comparing rigid versus dynamic syndesmotic fixation is growing, and a paradigm shift toward the latter is the new standard of treatment. Suture-button fixations show comparable clinical outcomes to screw-based constructs. The advantages of this implant include congruent syndesmosis reduction while allowing physiologic motion, less risk of hardware-related symptoms, early weight-bearing, and mobilization without risk of implant failure.