THE TREATMENT OF ROTATIONAL INSTABILITY IN THE ANKLE JOINT IN ASSOCIATION OF SPECIAL INJURY OF THE POSTERIOR SYNDESMOSIS

Abstract

Rotational instability is defined as combined medial and lateral ligament instability of the ankle joint. In the case of combined injury to the posterior syndesmosis and posterior joint portion the typical giving-away-symptoms and the therapy resistant complaints are accompanied. In the following prospective study 43 patients between the ages of 16 and 35 with the average age of 23.9 years with posttraumatic chronic joint-instability as well as posterior syndosmosis insufficiency were examined.

The treatment of rotational instability was performed by an anchoring technique modified by Broström. The resulting insufficiency of the posterior syndesmosis was treated by a Tight Rope provided by Arthrex.

The study was run over 14 months, where only 36 out of 43 patients were available for postoperative follow up. A preoperative baseline 2-view x-ray as well as an MRI was performed in all patients. The operation to establish the stability of the ligaments via anchoring-technique and the treatment of the posterior syndesmosis through Tight-Rope were performed via arthroscopy of the ankle joint with additional inspection of the posterior joint portion. At the same time existent impingements were recessed. In each patient the AOFAS score as an indicator for the treatement outcome and the VAS-score was used as the measurement for the level of pain developement were used.

The first exam was performed in preoperative setting followed by subsequent 12 and 24 weeks as well as 12 and 14 months postoperatively. To ensure stability a preoperative x-ray in suppination stress was performed followed by the same type of x-ray 3 months postoperatively. A significant improvement in the above mentioned scores were noted already 3 months after the operation. An improvement in VAS-score of 5.1 points as well as in AOFAS-score of 79% was observed. The degree of Suppination and rotational movement as well as the extent of talus-forfall has reduced significantly. The already improvement of the above scores after 3-month-follow up were consistent even after 14 months. About 90% of patients were satisfied with the outcome of the operation with the “good” and “very good” scores. The complication rate was about 3%.

In conclusion, the treatment of posttraumatic mechanical ankle joint instability with posterior syndesmosis injury via anatomic anchoring reconstructive technique and Tight-Rope is considered to be an operative modality with significantly satisfactory results.

Keywords: Rotational instability, posterior syndesmosis, stabilisation, tight-rope