- The Injury: The ankle syndesmosis is the joint between the tibia and the fibula near the ankle. It is primarily made up of three ligaments: the anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL), and the posterior inferior tibiofibular ligament (PITFL). An injury to one or more of these structures can lead to instability in the ankle joint. These injuries can range from mild ankle sprains that affect one ligament to more severe high ankle sprains and ankle fractures where more ligaments are involved.
- The Repair: Repairing the syndesmosis can involve the use of one or more Syndesmosis TightRope implants. In the operating room, the TightRope implant is flexible enough to put the bones where they belong and strong enough to keep them there. Additional Arthrex devices may be used in conjunction with the TightRope construct to repair the ligaments and restore the anatomy, such as the InternalBrace™ Ligament Augmentation procedure. Due to the high stress on this joint during rehabilitation, a small buttress plate is often used to help disperse the forces on the bone.
- Advantages of the Arthrex Syndesmosis TightRope Implant: The Arthrex Syndesmosis TightRope implant has over 40 dedicated clinical studies. These studies have highlighted a faster rehabilitation and return to play1, reduced rates of malreduction2, decreased reoperation rates3, and an increased cost effectiveness4. The TightRope implant system has continued to outperform alternative methods for syndesmosis repair5.
- Return to Play: Elite athletes may return to activity beginning at about 3-4 weeks, but 1-2 months is more common based on physical therapy, trainers and the patient6.
- History: The first Syndesmosis TightRope
® repair was performed in 2005 and the device has been continually improved to further the Arthrex mission of Helping Surgeons Treat Their Patients Better®.
- Patients: Since 2005, over 700,000 Arthrex Syndesmosis TightRope constructs have been implanted and it has become one of the most trusted devices in the Arthrex portfolio. It is available to all patients, not just elite athletes.
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References:
- Colcuc C, Blank M, Stein T, Raimann F, Weber-Spickschen S, Fischer S, Hoffmann R. Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3156-3164. doi: 10.1007/s00167-017-4820-3. Epub 2017 Dec 9. PMID: 29224059.
- Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2019 Sep;47(11):2764-2771. doi: 10.1177/0363546518804804. Epub 2018 Nov 26. PMID: 30475639.
- Grassi A, Samuelsson K, D'Hooghe P, Romagnoli M, Mosca M, Zaffagnini S, Amendola A. Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2020 Mar;48(4):1000-1013. doi: 10.1177/0363546519849909. Epub 2019 Jun 12. PMID: 31188642.
- Neary KC, Mormino MA, Wang H. Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis. Am J Sports Med. 2017 Jan;45(1):210-217. doi: 10.1177/0363546516664713. Epub 2016 Sep 30. PMID: 27601151.
- Sanders D, Schneider P, Taylor M, Tieszer C, Lawendy AR; Canadian Orthopaedic Trauma Society;. Improved Reduction of the Tibiofibular Syndesmosis With TightRope Compared With Screw Fixation: Results of a Randomized Controlled Study. J Orthop Trauma. 2019 Nov;33(11):531-537. doi: 10.1097/BOT.0000000000001559. PMID: 31633643.
Voight ML, Norman C, Wilk KE, Lucas M, Wolfe C. Management of High Ankle Sprains Utilizing the Tightrope Surgical Procedure - A Novel Approach for a Rapid Return to Play. Int J Sports Phys Ther. 2024 May 2;19(5):513-521. doi: 10.26603/001c.116862. PMID: 38707856; PMCID: PMC11065778.
