C Niek van Dijk1, Umile Giuseppe Longo2, Mattia Loppini3, Pino Florio4, Ludovica Maltese4, Mauro Ciuffreda4, Vincenzo Denaro4. 1. Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. 2. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy. g.longo@unicampus.it. 3. Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. 4. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
Abstract
PURPOSE: The aim of the present study was to perform a systematic review of the current classification systems, and the clinical and radiological tests for the acute isolated syndesmotic injuries to identify the best method of classification and diagnosis allowing the surgeon to choose the appropriate management. METHODS: A systematic review of the literature according to the PRISMA guidelines has been performed. A comprehensive search using various combinations of the keywords "classification", "grading system", "ankle injury", "ligament", "syndesmotic injury", "internal fixation", "acute", "synostosis", "ligamentoplasties", "clinical", "radiological" over the years 1962-2015 was performed. The following databases were searched: MEDLINE, Google Scholar, EMBASE and Ovid. RESULTS: The literature search resulted in 345 references for classification systems and 308 references for diagnosis methods, of which 283 and 295 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included 27 articles describing classification systems and 13 articles describing diagnostic tests for acute isolated syndesmotic injuries. CONCLUSIONS: The ESSKA-AFAS consensus panel recommends distinguishing acute isolated syndesmotic injury as stable or unstable. Stable injuries should be treated non-operatively with a short-leg cast or brace, while unstable injuries should be managed operatively. The recommended clinical tests include: tenderness on palpation over the anterior tibiofibular ligament, the fibular translation test and the Cotton test. Radiographic imaging must include an AP view and a mortise view of the syndesmosis to check the tibiofibular clear space, medial clear space overlap, tibial width and fibular width. LEVEL OF EVIDENCE: IV.
PURPOSE: The aim of the present study was to perform a systematic review of the current classification systems, and the clinical and radiological tests for the acute isolated syndesmotic injuries to identify the best method of classification and diagnosis allowing the surgeon to choose the appropriate management. METHODS: A systematic review of the literature according to the PRISMA guidelines has been performed. A comprehensive search using various combinations of the keywords "classification", "grading system", "ankle injury", "ligament", "syndesmotic injury", "internal fixation", "acute", "synostosis", "ligamentoplasties", "clinical", "radiological" over the years 1962-2015 was performed. The following databases were searched: MEDLINE, Google Scholar, EMBASE and Ovid. RESULTS: The literature search resulted in 345 references for classification systems and 308 references for diagnosis methods, of which 283 and 295 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included 27 articles describing classification systems and 13 articles describing diagnostic tests for acute isolated syndesmotic injuries. CONCLUSIONS: The ESSKA-AFAS consensus panel recommends distinguishing acute isolated syndesmotic injury as stable or unstable. Stable injuries should be treated non-operatively with a short-leg cast or brace, while unstable injuries should be managed operatively. The recommended clinical tests include: tenderness on palpation over the anterior tibiofibular ligament, the fibular translation test and the Cotton test. Radiographic imaging must include an AP view and a mortise view of the syndesmosis to check the tibiofibular clear space, medial clear space overlap, tibial width and fibular width. LEVEL OF EVIDENCE: IV.
Authors: Christopher S Ahmad; Lauren H Redler; Michael G Ciccotti; Nicola Maffulli; Umile Giuseppe Longo; James Bradley Journal: Am J Sports Med Date: 2013-05-23 Impact factor: 6.202
Authors: Paul F Förschner; Knut Beitzel; Andreas B Imhoff; Stefan Buchmann; Georg Feuerriegel; Felix Hofmann; Dimitrios C Karampinos; Pia Jungmann; Jonas Pogorzelski Journal: Orthop J Sports Med Date: 2017-04-27
Authors: João Carlos Rodrigues; Alexandre Leme Godoy Santos; Marcelo Pires Prado; José Felipe Marion Alloza; Renato Amaral Masagão; Laercio Alberto Rosemberg; Durval do Carmo Santos Barros; Adham do Amaral E Castro; Marco Kawamura Demange; Mario Lenza; Mario Ferretti Journal: BMJ Open Date: 2020-09-03 Impact factor: 2.692
Authors: Jorge de-Las-Heras Romero; Ana María Lledó Alvarez; Fernando Moreno Sanchez; Alejandro Perez Garcia; Pedro Antonio Garcia Porcel; Raul Valverde Sarabia; Marina Hernandez Torralba Journal: EFORT Open Rev Date: 2017-09-21