SLR - January 2023 - Aleksander Ferbet, DPM
Title: A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw FixationReference: Altmeppen JN, Colcuc C, Balser C, Gramlich Y, Klug A, Neun O, Manegold S, Hoffmann R, Fischer S. A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw Fixation. Journal of Clinical Medicine. 2022; 11(9):2524.
Reviewed By: Aleksander Ferbet, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, Missouri
Podiatric Relevance: Syndesmotic injuries are frequently encountered by foot and ankle surgeons. There are multiple different methods used to achieve reduction of the syndesmosis. Recently, the knotless suture-button has grown in popularity as an alternative to syndesmotic screw fixation due to potential biomechanical advantages. Prior studies have examined short term differences between these fixation techniques looking at variables such as return to play or work time and clinical scores. This study aims to directly compare long-term clinical outcomes between suture button fixation and syndesmotic screw fixation in acute syndesmotic injuries.
Methods: A level 1 monocentric randomized control trial was performed on patients who underwent acute syndesmotic repair utilizing either a knotless suture button device or a 3.5mm syndesmotic tricortical screw. A total of 41 participants were included in the study including 21 who underwent repair with the suture button and 20 who underwent repair with syndesmotic screws. Clinical outcomes were then assessed utilizing Activities of Daily Living (ADLs), American Orthopaedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score (OMAS) and the Foot and Ankle Disability Index (FADI) at 1 year post-operatively. OMAS and FADI were then collected again at approximately 9.5 years post-operatively.
Results: The knotless suture button and syndesmotic screw groups did not differ significantly in terms of ADL, AOFAS, FADI or OMAS scores at the 1 year follow up mark. The 10 year follow up scores did favor the suture button group, however, the syndesmotic screw group’s scores also improved and there was no significant statistical difference between the two techniques. The only significant difference observed in the study was the return to play time,which favored the suture button group. All patients who underwent syndesmotic screw fixation underwent screw removal at 7 weeks. A total of 9 patients in the suture button group underwent hardware removal due to local irritation within the first two years post-operatively. Chronic syndesmotic insufficiency was not observed in any of the patients in the study.
Conclusions: The authors conclude that both the suture button and syndesmotic screw procedures were sufficient treatments for acute syndesmotic injuries. The long-term results confirm very good clinical scores for both groups and not a single case of chronic syndesmotic insufficiency was observed. This study reinforces the fact that in non-athletes, the surgeon should proceed with whichever fixation method that they are more comfortable with when treating these acute injuries. While this study was a great starting point for the long-term effects of these procedures, future long-term studies with larger patient populations would be beneficial in distinguishing advantages and disadvantages of each procedure.