Hunt Kenneth J, Bartolomei Jonathan, Challa Shanthan C, McCormick Jeremy J, D'Hooghe Pieter, Tuffiash Michael, Amendola Annunziato
University of Colorado - Denver, Department of Orthopedics, Denver, CO, USA.
University of Colorado - Denver, Department of Orthopedics, Denver, CO, USA.
J ISAKOS. 2022 Feb;7(1):13-18. doi: 10.1016/j.jisako.2021.10.005. Epub 2021 Nov 17.
Although the body of literature on syndesmosis injuries is growing with regard to both the biomechanics and clinical outcomes for various fixation constructs, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavoured to assess the current approaches to managing syndesmotic injuries through a Research Electronic Data Capture survey.
The survey consisted of 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment and technique, and postoperative management. Responses were generated through six different athlete scenarios: moderate impact, high impact, and very high impact athletes with/without complete deltoid injury. Frequencies and percentages were calculated for all categorical responses.
A total of 742 providers responded to the survey, including 457 American surgeons and 285 members of various international societies. Flexible devices were the preferred fixation construct (47.1%), followed by screws (29.6%), hybrid fixation (e.g. combination of flexible device and screw, 18%), and other (5.3%). Sixty-four percent of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated return to full participation, largely dependent on the presence or absence of a deltoid ligament injury.
The most common elements used as surgical indications were syndesmosis widening > 2 mm on x-ray, an anterior inferior talofibular ligament injury in combination with a posterior inferior talofinular ligament or deltoid ligament involvement on magnetic resonance imaging, and widening of the distal tibiofibular joint during arthroscopic evaluation. Overall, flexible fixation (e.g. suture button) was the preferred device choice for the repair of an injured syndesmosis. Most respondents did not alter their rehab protocol or anticipated return to play timeline based on the injury severity. However, there was considerable variability between respondents on the time to weight-bearing, running, and full participation. Further pragmatic outcomes data are necessary to guide safe return to play protocols for syndesmotic injuries.
Level IV.
尽管关于下胫腓联合损伤的文献在各种固定结构的生物力学和临床结果方面不断增加，但对于这些损伤的最佳治疗方法和恢复运动策略几乎没有共识。我们试图通过一项研究电子数据采集调查来评估当前管理下胫腓联合损伤的方法。
该调查包括27个问题，包括受访者的人口统计学信息、下胫腓联合损伤的治疗指征、首选的治疗方法和技术以及术后管理。通过六种不同的运动员场景生成回复：中度撞击、高度撞击以及有/无三角韧带完全损伤的极高撞击运动员。计算所有分类回复的频率和百分比。
共有742名提供者回复了调查，其中包括457名美国外科医生和285名来自各种国际协会的成员。柔性装置是首选的固定结构（47.1%），其次是螺钉（29.6%）、混合固定（如柔性装置和螺钉的组合，18%）以及其他（5.3%）。64%的受访者指出，他们的康复方案不会因每个运动员场景而改变。预期完全恢复参与的情况存在很大差异，这在很大程度上取决于是否存在三角韧带损伤。
用作手术指征的最常见因素是X线显示下胫腓联合增宽>2mm、磁共振成像显示距腓前韧带损伤合并距腓后韧带或三角韧带损伤以及关节镜评估时胫腓远端关节增宽。总体而言，柔性固定（如缝线纽扣）是修复损伤下胫腓联合的首选装置。大多数受访者不会根据损伤严重程度改变他们的康复方案或预期的恢复比赛时间线。然而，受访者在负重、跑步和完全参与的时间方面存在很大差异。需要进一步实用的结果数据来指导下胫腓联合损伤安全恢复比赛的方案。
四级。
