SLR - September 2012 - Jessica Kwan
Reference: Naqvi, G.A, Shafqat, A., and Awan, N. (2011). Tightrope fixation of ankle syndesmosis injuries: Clinical outcome, complications and technique modification. Injury, electronic format.
Scientific Literature Review
Reviewed by: Jessica Kwan, DPM
Residency Program: St. John Hospital and Medical Center, Detroit, MI
Podiatric Relevance:
Treatment of ankle syndesmotic injuries remains a controversial topic in podiatric and orthopaedic literature. Traditionally, the syndesmosis has been fixated utilizing screws. This article discusses a new technique for fixation of the ankle syndesmosis; namely utilizing the Arthrex tightrope. Early studies using the Arthrex tightrope have described soft tissue irritation over the prominent lateral knot. It is hoped that utilizing the new technique described in this study will avoid soft tissue complications and the need for the removal of the implant.
Methods:
A retrospective review of forty-nine patients treated with Arthrex tightrope for ankle diastasis was performed. The mean age of patients was 37.7 years of age. Patients with open fractures, multiple trauma, neuropathic arthropathy and pilon fractures were excluded.
The surgical technique consisted of number-five fiberwire held across the ankle syndesmosis utilizing two metal cortical buttons. Eighteen patients were initially treated using the standard technique of placing the Arthrex tightrope. Thirty-one patients were then treated using the author's modification of the technique, which included burying the knot of FiberWire laterally and posterior to the fibula within a recess created during the procedure. Periosteum and deep soft tissue were closed over the knot to avoid soft tissue complications.
Postoperatively, patients were immobilized in a below-knee non-weightbearing cast for six weeks prior to undergoing physical therapy. Patients were evaluated at two weeks, six weeks and between two to six months both clinically and radiographically.
Results:
Of the 18 patients on which the standard technique was performed, three required removal of the implant. The mean time to full weight-bearing was 7.7 weeks, and the mean duration to return to normal daily activities was 11.2 weeks. Of the 31 patients treated with the modification, none required implant removal. The mean AOFAS score postoperatively was 85.57 and the mean postoperative FADI score was 81.20. Eighty-five-point-seven percent of patients reported their outcome as excellent or very good and 12 percent reported their outcome as good. One patient reported a poor outcome.
Conclusions:
The technique described in this article is effective in providing stabilization to the syndesmosis and prevents the need for future retrieval of the implant, however, further research is needed.