Short-Term Results of Surgical Treatment Using TightRopeTM for Acute Ankle Syndesmosis Injury

Do Young Kim; Jun Hyuck Lee; Jung Hyun Park; Jaeho Cho

doi:10.14193/jkfas.2016.20.4.176

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Kim, Lee, Park, and Cho: Short-Term Results of Surgical Treatment Using TightRopeTM for Acute Ankle Syndesmosis Injury

Original Article

J Korean Foot Ankle Soc 2016;20(4):176-181.

Published online: 19 January 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.4.176

Short-Term Results of Surgical Treatment Using TightRope^TM for Acute Ankle Syndesmosis Injury

Do Young Kim^*, Jun Hyuck Lee^*, Jung Hyun Park^†, Jaeho Cho^*,^†

^*Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Korea

^†Department of Anatomy, College of Medicine, Kangwon National University, Chuncheon, Korea

Corresponding Author: Jaeho Cho Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon 24253, Korea Tel: 82-33-240-5198, Fax: 82-33-250-6224, E-mail: hohotoy@nate.com

Received 10 August 201620 September 2016 Accepted 5 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to evaluate the clinical and radiologic outcome of syndesmosis fixation using TightRope^TM (Arthrex, Naples, FL, USA) in acute syndesmosis injuries.

Materials and Methods:

Twenty-five consecutive patients with acute syndesmosis injuries, treated using TightRope^TM, were reviewed. Patients were evaluated preoperatively and at the last follow-up (at least 12 months postoperatively). Clinical outcomes were assessed using American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score and self-subjective satisfaction survey. Three radiologic parameters were evaluated two times at the preoperative and final follow up from the nonweightbearing ankle anteroposterior radiographs.

Results:

The mean AOFAS ankle-hindfoot score was 95.5 at the final follow-up. According to the satisfaction survey, 21 patients chose excellent, and four patients chose good. All radiologic parameters, including the mean tibiofibular clear space, mean tibiofibular overlap, and mean medial clear space on nonweightbearing ankle anteroposterior view, significantly improved after surgery. Complications occurred in only one patient who experienced knot irritation with infection.

Conclusion:

The short-term surgical results of syndesmosis fixation using TightRope^TM were good to excellent, both clinically and radiographically. These results suggest that the fixation using TightRope^TM is a valid option for acute syndesmosis injury.

Keywords: Ankle fractures, Ankle syndesmosis, Orthopedic fixation devices

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Table 1.

Demographics and Patient Summary Results

Variable	Value
Patient	25
TightRope^TM	30
Demographics
Mean age (yr)	24.2 (20∼30)
Gender
Male	25 (100)
Female	0 (0)
Tightropes used
1	20 (80.0)
2	5 (20.0)
Injury pattern
SER	9 (36.0)
PER	9 (36.0)
Maisonneuve fracture	7 (28.0)
Mean follow-up (mo)	17.5 (12∼24)
Mean last follow-up AOFAS score	95.5 (86∼100)
Complication
Knot irritation and infection	1 (4.0)

Values in the parenthesis are either percentage or range. SER: supination-external rotation, PER: pronation-external rotation, AOFAS: American Orthopaedic Foot and Ankle Society.

Figure 1.

(A) Preoperative nonweightbearing anteroposterior radiograph of a right ankle demonstrates supination-external rotation type ankle fracture. (B) Final non-weightbearing anteroposterior radiograph show no evidence of syndesmosis widening.

Figure 2.

Three radiographic parameters were measured from non-weightbearing anteroposterior (AP) radiographs. Tibiofibular clear space (TFCS, α) is distance between the medial border of the fibula and the lateral border of the tibia. The TFCS is measured 1 cm proximal to the plafond. Tibiofibular overlap (β) is the overlap of the lateral malleolus and the anterior tibial tubercle measured 1 cm proximal to the plafond. Medial clear space (γ) is distance between the articular surfaces of the talus and the medial malleolus.

Figure 3.

(A) Preoperative anteroposterior radiograph of a right ankle demonstrates pronation-external rotation type ankle fracture. (B) Open reduction and internal fixation with syndesmosis fixation was performed. (C) All implants were removed at 4 months due to soft tissue irritation and deep infection. (D) At one-year follow up after implant removal, radiograph show complete bone union and adequately maintained ankle mortise.

Table 2.

Radiographic Measurements

Parameter	Initial	Final follow-up	p-value
TFCS (mm)	6.2±2.2	3.2±0.9	<0.001
TFO (mm)	2.0±1.8	5.9±1.6	<0.001
MCS (mm)	5.8±3.0	2.4±0.4	<0.001

Values are presented as mean±standard deviation. TFCS: tibiofibular clear space, TFO: tibiofibular overlap, MCS: medial clear space.

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