Syndesmosis Injuries aka “High Ankle Sprains”

Syndesmosis injuries, commonly referred to as high ankle sprains, can have a significant impact on athletes participating in high-impact sports. These injuries involve damage to the syndesmosis, a network of ligaments that connect the tibia and fibula bones in the lower leg. In this blog, we will delve into the nature of syndesmosis injuries, their causes, common signs and symptoms, and explore the typical rehabilitation and physiotherapy management.

We will also highlight the experiences of two notable rugby league players, Josh Addo Carr and Jai Arrow, who both underwent tight-rope fixation surgery to recover from high-grade syndesmosis sprains. Additionally, we will discuss the differences between tight-rope fixation and normal screw fixation regarding pain management and return to play.

What does the syndesmosis involve:

The syndesmosis comprises ligaments connecting the tibia and fibula bones. The primary ligaments involved are the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), and the interosseous membrane.

Signs and Symptoms:

– The pain is often localized to the front or outer aspect of the ankle and may worsen with weight-bearing activities.

– Swelling and bruising around the ankle area may be present, indicating tissue damage and inflammation.

– Individuals with a high ankle sprain may also experience difficulty bearing weight and walking due to pain and instability.

– Reduced range of motion in the ankle joint, along with a feeling of the ankle giving way or being unstable, are also common.

These signs and symptoms, when observed following an ankle injury, should raise suspicion for a syndesmosis injury and prompt appropriate evaluation and management.

Causes and Mechanism of Injury (MOI):

Syndesmosis injuries are typically caused by excessive external rotation or a combination of rotation and dorsiflexion of the ankle. They commonly occur during sports activities that involve sudden changes in direction, pivoting, or direct trauma to the lower leg. Diagnosis of syndesmosis injuries usually involves a physical examination of the ankle joint, as well as imaging tests such as X-rays or MRI scans.

Rehabilitation and Non-surgical Physiotherapy Management:

Rehabilitation and physiotherapy play a crucial role in the recovery of syndesmosis injuries. The typical management strategies include:

– Rest, ice, compression, and elevation (RICE) in the acute phase to reduce swelling and pain.

– Immobilization using a walking boot or ankle brace to provide stability during the initial healing stage.

– The gradual introduction of weight-bearing activities, as guided by a healthcare professional, to restore strength and stability.

– Range of motion exercises to improve ankle mobility.

– Strengthening exercises targeting the surrounding muscles, especially the calf muscles.

– Proprioception and balance training to enhance joint stability.

– Sport-specific exercises and drills to simulate game movements and prepare for a return to play.

Examples of High-Grade Syndesmosis Sprains:

a. Josh Addo Carr: The New South Wales (NSW) Origin player and former Canterbury-Bankstown Bulldogs winger experienced a high-grade syndesmosis sprain, requiring tight-rope fixation surgery to aid his recovery.

b. Jai Arrow: Representing the South Sydney Rabbitohs and the Queensland State of Origin team, Arrow suffered a high-grade syndesmosis sprain. He also underwent tight-rope fixation surgery to facilitate his rehabilitation.

Surgical Management: Tight-Rope Fixation vs. Screw Fixation:

Tight-rope fixation and screw fixation are two surgical techniques used to stabilize syndesmosis.

Tight Rope Fixation

The key difference between tightrope fixation and screw fixation lies in how the syndesmosis is stabilized during the healing process. In traditional screw fixation, the injured ligaments are held in place using screws inserted through the bones of the lower leg. While this method has been effective in providing stability, it can be associated with a longer recovery period due to the time required for bone healing and subsequent removal of the screws.

On the other hand, tightrope fixation utilizes a specialized device that creates a dynamic and adjustable fixation of the syndesmosis. This technique involves passing a strong, flexible, and adjustable suture-like material, commonly referred to as a “tightrope,” through tunnels in the tibia and fibula bones. The tightrope is then tensioned to provide the necessary stability while allowing controlled motion between the bones during the healing process.

The dynamic nature of the fixation allows for controlled and earlier mobilization, reducing the risk of stiffness and muscle atrophy associated with prolonged immobilization. Moreover, the absence of screws eliminates the need for a second surgical procedure for screw removal, allowing athletes to focus on their rehabilitation and return to their sport more efficiently.

While the use of tightrope fixation shows promise in facilitating a quicker return to play, it is important to note that each injury is unique, and the choice of fixation method should be determined based on various factors, including the severity of the injury, the athlete’s specific circumstances, and the advice of the medical team.

Syndesmosis injuries, commonly referred to as high ankle sprains, can significantly impact athletes participating in high-impact sports. Recognizing the causes, signs, and symptoms of these injuries, along with implementing appropriate rehabilitation and physiotherapy management, is essential for a successful recovery.

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Jamie has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Jamie has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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