Pure Syndesmotic Injuries in Amateur Athletes: Diagnosis and Clinical-Functional Outcomes After Elastic Fixation

Research Type: Level 4 – Case series Introduction/Purpose: Syndesmotic injuries account for 1%–18% of all ankle sprains and are common in sports, with an incidence of 12%–32% among athletes. These injuries may also be associated with other concomitant lesions and require appropriate management to prevent long-term complications. The elastic fixation system allows for a controlled degree of physiological micro-movement, facilitating early functional rehabilitation. This technique offers potential advantages, including the elimination of implant removal, a lower incidence of malreduction, and improved range of motion. This study aims to describe our diagnostic and therapeutic protocol and to report the clinical and functional outcomes of patients with pure syndesmotic injuries (without associated fractures) treated with an elastic fixation system. Methods: Patients with fractures of the medial malleolus, posterior malleolus, or fibula were excluded. We report 37 patients evaluated retrospectively who had pure syndesmotic injuries during sports activity, treated surgically with an elastic fixation system, and with a minimum follow-up of 24 months. For diagnosis, physical examination, X-rays, and magnetic resonance imaging (MRI) were employed. Data collected included return to previous physical activity, complications, demographics, radiographic arthritic changes, injury types by MRI, and satisfaction level. Patients were clinically followed using measurement tools such as the AOFAS score, FAAM ADL, and FAAM Sport. Results: We obtained excellent functional outcomes in the evaluated variables: AOFAS median of 90 (IQR 88, 100), FAAM ADL median of 100 (IQR 98, 100), and FAAM Sport median of 95 (IQR 90, 100). 84% were able to return to their previous level of physical activity and all the patients reported being satisfied with the procedure and its outcomes. The most frequent injury pattern was the anterior syndesmosis injury, observed in 55% of the cases, followed by combined injury in 45%. We did not report any cases of isolated posterior syndesmosis injury. No significant radiographic arthritic changes or complications were observed. Conclusion: This procedure demonstrated good clinical and functional outcomes, with high patient satisfaction, sports return, and no complications. Long-term, multicenter studies with larger sample sizes would be needed in the future to further expand knowledge in this field.