Ankle Syndesmosis Repair and Rehabilitation in Professional Rugby League Players: a Case Series Report

Overview

Journal BMJ Open Sport Exerc Med

Specialty Orthopedics

Date 2017 Aug 2

PMID 28761696

Citations 12

Authors

Alex James Latham

Peter Charles Goodwin

Ben Stirling

Adam Budgen

Affiliations

Soon will be listed here.

Abstract

Background/aim: The distal tibiofibular joint is described as a syndesmosis. Traditionally, severe syndesmotic injuries with diastasis have been treated surgically with screw fixation. This case series details an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. The aim of this study was to describe players' journey from injury, through diagnosis to surgery, rehabilitation and return to participation, detailing time scales and methods used at each stage to highlight the change in current practice.

Methods: Players were identified via a single orthopaedic surgeon in the UK who specialises in ankle syndesmosis repair. Between January 2010 and September 2015, adult men playing full-time professional rugby league in the UK Super League with ankle syndesmosis injuries were identified.

Results: Eighteen players from six different clubs were included. The most common mechanism of injury was forced dorsiflexion/eversion. The average return to participation was 64 days (SD 17.2, range 38-108). This compares favourably to reports of between 120 and 180 days following screw fixation.

Conclusion: Ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol is as safe as traditional methods. The accelerated rehabilitation protocol promotes early weight-bearing and has shown to expedite the return to sport for professional Rugby League players. It is possible to return to sport 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This is extremely encouraging for the professional sporting population.

Citing Articles

A systematic review of studies on the diagnostics and classification system used in surgically treated, acute, isolated, unstable syndesmotic injury: a plea for uniform definition of syndesmotic injuries.

Spindler F, Bocker W, Polzer H, Baumbach S EFORT Open Rev. 2024; 9(1):16-24.

PMID: 38193495 PMC: 10823566. DOI: 10.1530/EOR-23-0097.

Return to Play After Isolated Syndesmotic Ligamentous Injury in Athletes: A Systematic Review and Meta-analysis.

Salameh M, Hantouly A, Rayyan A, Dabbas J, Toubasi A, Hartnett D Foot Ankle Orthop. 2022; 7(2):24730114221096482.

PMID: 35601091 PMC: 9121478. DOI: 10.1177/24730114221096482.

Application of an arched, Ni-Ti shape-memory connector in repairing distal tibiofibular syndesmosis ligament injury.

Zhao J, Zhang Y, Xia Y, Wang X, Xu S, Xie Y BMC Musculoskelet Disord. 2022; 23(1):476.

PMID: 35590289 PMC: 9118800. DOI: 10.1186/s12891-022-05449-9.

Current status of the management of isolated syndesmotic injuries in Germany.

Mutschler M, Naendrup J, Pfeiffer T, Jaecker V, Arbab D, Shafizadeh S Arch Orthop Trauma Surg. 2022; 143(4):2019-2026.

PMID: 35403865 PMC: 10030432. DOI: 10.1007/s00402-022-04423-3.

Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts.

Pogliacomi F, De Filippo M, Casalini D, Longhi A, Tacci F, Perotta R World J Orthop. 2021; 12(5):270-291.

PMID: 34055585 PMC: 8152437. DOI: 10.5312/wjo.v12.i5.270.

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