Article Text

There is no best surgical treatment for chronic isolated syndesmotic instability: a systematic review
  1. Bart Lubberts1,
  2. Pim A D van Dijk1,
  3. James D Calder2,3,
  4. Christopher W DiGiovanni4,5
  1. 1Orthopaedic Foot and Ankle Service, Massachusetts General Hospital—Harvard Medical School, Boston, Massachusetts, USA
  2. 2Fortius Clinic, London, UK
  3. 3Imperial College London, London, UK
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Newton, Massachusetts, USA
  1. Correspondence to Bart Lubberts, Orthopaedic Foot and Ankle Service, Massachusetts General Hospital—Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; blubberts{at}


Importance Appropriate management of chronic isolated ankle syndesmotic injuries is needed to prevent the development of concomitant pathology. Previous studies have evaluated treatment and outcomes of chronic syndesmotic injuries. However, these studies did not distinguish between isolated—an injury without associated fibula fracture—and non-isolated syndesmotic injuries.

Objective We conducted a systematic review to assess the functional outcomes and determine evidence for optimal management of chronic isolated syndesmotic injuries.

Evidence review A review of the literature was performed according to the PRISMA guidelines. PubMed, EMBASE and the Cochrane Library were searched on 2 May 2016. Studies were identified by using synonyms for ‘ankle syndesmosis’, ‘injury’, ‘delayed’, ‘chronic’ and ‘treatment’.

Findings The search resulted in 216 reports on PubMed, 86 on EMBASE and 3 on the Cochrane Library. After reading the remaining full-text articles, we included 11 studies describing outcomes after surgical management of chronic unstable isolated injuries.

Conclusions and relevance Currently, there is no evidence to support or refute any of the surgical interventions performed for chronic unstable isolated syndesmotic injuries. High level of evidence research is warranted if we want to establish optimal treatment.

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