SLR - February 2018 - Patrick M. Donovan

Lower Complication Rate and Faster Return to Sports in Patients with Acute Syndesmotic Rupture Treated with a New Knotless Suture Button Device

Reference: Colcuc, C., Blank, M., Stein, T., Raimann, F., Weber-Spickschen, S., Fischer, S., & Hoffmann, R. (2017). Lower Complication Rate and Faster Return to Sports in Patients with Acute Syndesmotic Rupture Treated with a New Knotless Suture Button Device. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 2017.

Scientific Literature Review

Reviewed By: Patrick M. Donovan, DPM
Residency Program: UF Health Jacksonville, Jacksonville, FL

Podiatric Relevance: Podiatric physicians routinely treat injured athletes at all levels. Return to function is of utmost importance and paramount to an athlete’s care. Treatment of these injuries should allow athletes the quickest return to sport without ancillary procedures. An estimated 10 percent of all ankle fractures are associated with syndesmotic disruption. Suture button devices for tibiofibular joint injuries provide flexible/dynamic stabilization. This study was performed to compare the clinical outcomes, complication rates and time to return to sports between a knotless suture button device and syndesmotic screw fixation.

Methods: This randomized controlled trial study for treatment of ankle syndesmotic injuries from 2012 to 2014 with a knotless suture button device (TightRope) or syndesmotic screw fixation. Primary outcomes were measured using the American Orthopaedics Foot and Ankle Society (AOFAS) score, Foot and Ankle Disability Index (FADI), Olerud and Molander score and visual analog scale for pain and function. Secondary outcomes were the complication rate and time required to return to sports. All operations were performed by the senior author and two attending surgeons. Syndesmotic repairs were dependent on the outcome of the randomization: either with the knotless TightRope device or using a 3.5 mm transosseous syndesmotic screw purchasing three cortices. Patients underwent clinical and radiological evaluations preoperatively and three times during the one-year postoperative follow-up.

Results: Fifty-four of 62 patients were analyzed, median age of 37 years old (18–60) and underwent the full one-year follow-up. The screw fixation (26) and knotless suture button groups comprised (28) patients. There were no significant differences in the demographic data between the two groups. There were no significant differences at the last follow-up in the AOFAS score, Olerud and Molander score or FADI Score. The complication rate was significantly lower (p=0.03), and time to return to sports was significantly shorter in the knotless suture button than screw fixation group (average, 14 versus 19 weeks, respectively; p=0.006). Age, injury, mechanism and body mass index was not significant with time required to return to sports activities. Knotless TightRope fixation returned to work earlier than did patients who underwent screw fixation (average, nine and 11 weeks, respectively), however, this was not statistically significant. No significant differences were identified in pain between the groups. The type of fixation was the only independent variable that reached statistical significance (p=0.006).

Conclusions: Continuous play, or having little to no off-season due to perpetual training, can commonly lead to injuries. Treatment of these injuries should allow athletes the quickest return to sport. Syndesmotic screw fixation and the Knotless TightRope suture button device both resulted in good clinical results when compared. However, when return-to-sport times were compared, the knotless suture button device allowed an expedited return to activity without the need for secondary removal of hardware. In the future, we may be able to apply this early return to activity to our nonathletic patients; however, further studies would need to be performed.

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