The FSI Conference 2021: Pieter D’Hooghe

Ankle sprains and syndesmosis (sometimes called “high-ankle sprains”) are completely different injuries, as the latter occur with external rotation and dorsiflexion of the ankle, although in 20% of ankle sprains it seems to be concurrent to a syndesmotic injury. The incidence of syndesmotic injuries is 0.05 injuries per 1000 hours of play, mean absence around 5 weeks, 74% of them contact-related and where a 7.5% annual increase has been shown in the last 15 years in professional football.

The diagnosis consists of listening (throughout history), looking (imaging) and feeling (clinical examination – provocative tests) the player’s ankle. Syndesmotic injuries are categorised into grade 1 (incomplete injury to the lateral ligaments, never requiring surgery), grade 2 (partial ligament disruption, sometimes requiring surgery) and grade 3 (complete injury to the ligaments, always requiring injury), where an important aspect of the grade 2 injuries is whether it causes instability. Where instability is present, an arthroscopy may be performed to further evaluate the instability and obtain an accurate diagnosis.

Regarding the treatment, there are two dominant techniques: screws or suture buttons. The suture option may be a better option to reduce complications and improve clinical outcomes. Malreduction is one of the concerning complications that screw treatment of syndesmotic injuries may cause and suture buttons may prevent.

The ankle syndesmosis mechanism is quite similar to the ACL injury, with the only difference being in the plant foot (flat foot in ACL and only forefoot stuck in syndesmotic ankle injuries) which may have important implications in diagnosis and treatment. The return to field training from isolated unstable syndesmotic ankle injuries is around 37 days; return to training with the team around 72 days; and return to competition 103 days, although there exist some specifications regarding the context of the injury and the player.

Key words: syndesmosis injuries, high-ankle injury, surgery, rehabilitation.