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Direct Ligament Repair in Syndesmotic Injury

Updated: Aug 24, 2022

There is nothing like syndesmotic injuries to inspire debate between the orthopedic trauma and foot and ankle communities. Screw fixation, suture button fixation, removal of screws, and timing all go into this lively debate. But what if we can repair the anterior inferior tibio-fibular ligament instead of trans-sydesmotic fixation?

Testing sydesmosis stability with different repairs

In their article, "Anterior Inferior Tibiofibular Ligament Suture Tapge Augmentation for Isolated Syndesmotic Injuries," Marissa D. Jamieson et al. examined 12 lower leg specimens with MTS machine. Testing conditions included intact sydesmosis, AITFL suture repair, AITFL suture repair and trans-sydesmotic button(SB), and AITFL suture repair augmented with suture tape among others. Motion capture system was used to study spatial relationship between tibia, talus and fibula. In this isolated syndesmotic injury model, the AITFL suture repair + AITFL augmentation best restored the rotational kinematics of the ankle.

AITFL suture repair + AIFTL augmentation is really good

The upshot of this study is that re-establishing rotational control by an augmented AITFL repair should be considered and controlled rotation better than the standard suture button alone.

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