Augmented Anterior Inferior Tibiofibular Ligament Repair in Ankle Fractures and the Postoperative Effect on 3D Syndesmotic Volumes

Submission Type: Ankle Fractures Research Type: Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results Introduction/Purpose: Dynamic fixation using the TightRope® (TR) system has led to improvements in outcomes after complex ankle syndesmotic injuries. Augmenting TR fixation with a repair of the anterior inferior tibiofibular ligament (TR+AITFL) has been proposed to reconstruct the syndesmosis more accurately. Clinical studies using this technique, however, are limited. The purpose of our study was to determine if surgical technique influenced short-term postoperative reduction of the syndesmosis and short- and mid-term patient-reported outcomes (PROs). We also explored relationships between postoperative volumes and PROs. Methods: Twenty patients with syndesmotic injuries participated in our randomized clinical pilot study. Participants were blinded and randomly assigned into TR (n=11; 50.5±13.3yrs) or TR+AITFL (n=9; 55.9±19.3yrs) groups. Postoperative reduction was assessed by 3D volumetric ratios and measured by weight-bearing CT at 6-weeks and 3-months post-operation. PROs were collected preoperatively, and at 6-weeks, 3-months, 6-months, and 1-year post-operation and included the Foot and Ankle Outcome Score and the RAND-36. Differences in volumetric ratios and PROs were evaluated between groups and time periods. Results: No statistically significant differences were found in syndesmotic volumetric ratios between groups at either time point. Very limited sample suggests an increase in postoperative volumes in those with Weber C fractures between 6-weeks and 3-months, and though not significant, these participants also had greater postoperative volumes than those with Weber B fractures. Both TR and TR+AITFL groups reported improved PRO scores after fixation, but surgical technique did not significantly influence them. Additionally, we did not find any relationship between volumetric ratios and PROs. Conclusion: TR stabilization with and without a repair of the AITFL produced similar short-term syndesmotic reduction outcomes and were equally effective at improving short- and mid-term PROs. Future studies with larger samples and those looking at the potential influence of these techniques in various fracture classifications are warranted.