Institut Grenoblois de Chirurgie du Pied, Centre Ostéoarticulaire des Cèdres, 5, Rue des Tropiques, 38130 Echirolles, France.
Capio Clinique des Cèdres, Château D'Alliez, 31700 Cornebarrieu, France.
Orthop Traumatol Surg Res. 2019 Dec;105(8S):S275-S286. doi: 10.1016/j.otsr.2019.09.014. Epub 2019 Oct 5.
The tibiofibular syndesmosis is a fibrous joint essential for ankle stability, whence the classical comparison with a mortise. Syndesmosis lesions are quite frequent in ankle trauma. This is a key element in ankle stability and lesions may cause pain or instability and, in the longer term, osteoarthritis. The lesions are often overlooked due to diagnostic difficulties, but collision sport with strong contact is the main culprit. Diagnosis, whether in the acute or the chronic phase, is founded on an association of clinical and paraclinical signs. Cross-sectional imaging such as MRI is fundamental to confirming clinical suspicion. Absence of tibiofibular diastasis no longer rules out the diagnosis. Stress CT and the introduction of weight-bearing CT are promising future diagnostic tools. Exhaustive osteo-ligamentous ankle assessment is necessary, as syndesmosis lesions may be just one component in more complex rotational instability. Therapeutically, arthroscopy and new fixation techniques, such as suture buttons, are opening up new perspectives, especially for chronic lesions (>6months). The present anatomic, epidemiological, diagnostic and therapeutic review does not preclude further clinical studies of rotational ankle instability with its strong risk of osteoarthritis.
下胫腓联合是一种纤维关节，对踝关节的稳定性至关重要，因此常被比作榫卯关节。踝关节创伤中经常会出现下胫腓联合损伤。这是踝关节稳定性的关键因素，损伤可能导致疼痛或不稳定，长期来看还会导致骨关节炎。由于诊断困难，这些损伤经常被忽视，但碰撞运动尤其是接触性强的运动是主要原因。诊断，无论是在急性期还是慢性期，都基于临床和影像学检查的综合判断。磁共振成像（MRI）等影像学检查对证实临床诊断至关重要。现在，即使没有出现下胫腓分离，也不能排除诊断。应力 CT 和负重 CT 的应用是很有前途的未来诊断工具。需要对踝部的所有骨和韧带进行全面评估，因为下胫腓联合损伤可能只是更复杂的旋转不稳定的一个组成部分。治疗方面，关节镜技术和新的固定技术，如缝线纽扣，为慢性损伤（>6 个月）开辟了新的治疗前景。本解剖学、流行病学、诊断和治疗综述并不能排除对具有较高骨关节炎风险的旋转性踝关节不稳定进行进一步的临床研究。
