SLR - February 2023 - Junaid Akbar, DPM
Title: The Effect of Stabilization Procedures on Sports Discipline and Performance Level in Non-Elite Athletes after Acute Syndesmotic Injury: A Prospective Randomized TrialReference: Colcuc C, Wähnert D, Raimann FJ, et al. The Effect of Stabilization Procedures on Sports Discipline and Performance Level in Non-Elite Athletes after Acute Syndesmotic Injury: A Prospective Randomized Trial. J Clin Med. 2022;11(15):4609. Published 2022 Aug 8. doi:10.3390/jcm11154609
Level of Evidence: 2-Prospective Cohort Study
Reviewed by: Junaid Akbar, DPM
Residency Program: Lenox Hill Hospital at Northwell Health
Podiatric Relevance: Syndesmotic injuries, isolated or associated with ankle fractures, may be troublesome for patients if not diagnosed and treated adequately. The two most common methods of fixation are screw fixation and/or knotless suture button. Podiatric surgeons tend to prefer one over the other regarding fixation, and some might even use both. Each fixation type comes with its own pearls and pitfalls, be it an ease of application, cost effectiveness, or removal of hardware. The aim of this study was to analyze patient outcomes following randomized syndesmotic fixation with screw versus suture button fixation in non-elite athlete patients, and with attention to suture button being superior to the screw fixation with time to return to normal function.
Methods: A prospective cohort study of 56 patients (2012-2015) in a single institution, 26 screw fixation and 21 suture button group. Lost to follow up were 2 and 7, respectively. Exclusion criteria consisted of no sports activity, contralateral ankle pathology, history of prior ankle pathology, and causative systematic conditions. Age, demographics, and various types of injury were all considered. Post-operative patients underwent a rehabilitation program with a physical therapist. Outcomes were assessed clinically (FADI, FAAM, VAS scores) and radiographically at 6/12m. Furthermore, all patients were divided based on activity levels.
Results: No statistical difference could be found between the FADI, FAAM and VAS-scores in both groups. VAS scores were noted to have improved from pre-op to last follow up with no significant differences. At 6 months: 6% of suture button pts and 11% of screw fixation were unable to return to stop and go sports or had chosen a less stressful sport. At 12 months: All suture button patients had returned to stop and go sports while 6% screw fixation had not. In endurance and individual level sport, both groups were able to return fully, except for 2 screw fixation patients. No difference can be seen in competitive sports amongst the two groups. Overall, 10% of screw fixation patients did not reach their previous level of performance at 6 months. All results showed no statistical significance. Chronic instabilities, radiograph diastasis, wound complications, or infections were not seen in both groups.
Conclusions: The study confirms that both screw and suture button fixation are viable for fixating syndesmotic injuries. The idea that suture button offers an advantage when it comes to time to return to sport was not of statistical significance, however, other studies have shown that dynamic fixation provided by suture button have had an early return to sports and the additional need for screw removal may not be needed. This study brings a great comparison of the two most common methods of fixation for syndesmotic injuries. The study's concise design and outcome measures were strong to evaluate the functional outcome of patients. When applying to one's own practice, consideration of patient compliance, return to sport level, and patient demographics must be considered when it comes to selecting screw fixation versus suture button.