A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw Fixation

Abstract

Background: Acute syndesmosis injury (ASI) is an indication for surgical stabilization if instability is confirmed. In recent years, fixation using the knotless suture-button (SB) device has become increasingly established as an alternative to set screw fixation (SF). This study directly compared the clinical long-term results after prospective randomized inclusion. Materials and Methods: Between 2011 and 2012, 62 patients with ASI were enrolled in a prospective, randomized, and monocentric study. Forty-one patients were available for a 10-year follow-up ((31 males and 10 females), including 21 treated with SB (mean age 44.4 years), and 20 with SF (mean age 47.2 years)). In addition to comparing the demographic data and syndesmosis injury etiology, follow-up assessed the Olerud−Molander Ankle Score (OMAS) and FADI-Score (Foot and Ankle Disability Index Score) with subscales for activities of daily living (ADL) and sports activity. Results: The mean OMAS was 95.98 points (SB: 98.81, SF: 93.00), the mean FADI ADL was 97.58 points (SB: 99.22, SF: 95.86), and the mean FADI Sport was 94.14 points (SB: 97.03, SF: 91.10). None of the measurements differed significantly between the groups (p > 0.05). No clinical suspicion of chronic instability remained in any of the patients, regardless of treatment. Conclusions: The short-term results showed that athletes in particular benefit from SB fixation due to their significantly faster return to sports activities. However, the available long-term results confirm a very good outcome in the clinical scores for both approaches. Chronic syndesmotic insufficiency was not suspected in any of the patients. Level of evidence: I, randomized controlled trial.

Keywords: suture-button device; syndesmotic injury; syndesmotic reduction; syndesmotic screw fixation.

Figure 1

Study flow chart.

Figure 2

Radiographic imaging. (a) Anteroposterior view of isolated Knotless Suture-button fixation (TightRope^®), left ankle, male 41 years. (b) Anteroposterior view of Plate fixation of Weber C fracture and Knotless Suture-button fixation (TightRope^®), right ankle, female 52 years.

Figure 3

Radiographic imaging. (a) Anteroposterior view of isolated Syndesmotic screw fixation, left ankle, male 45 years. (b) Anteroposterior view of Plate fixation of Weber B fracture and Syndesmotic screw fixation, right ankle, male 48 years.

Figure 4

Outcome over time. Mid- and long-term results at 1 and 10 years, respectively; ADL, activities of daily living; FADI, Foot and Ankle Disability Index; OMAS, Olerud–Molander Ankle Score.