Syndesmosis Rupture - Diseases of the Ankle Joint - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Syndesmosis Rupture

Syndesmosis rupture (syndesmosis tear/ tear of the interosseous membrane)

The syndesmosis is a ligament structure, which is necessary for the stabilisation of the ankle mortise joint. It is frequently injured due to distorsion and compression trauma of the ankle joint and the lower leg. This injury can lead to a loss of stability in the upper ankle joint and therefore an associated higher tendency for arthritis. An injury to the ligament structures of the ankle joint can also occur without a bony injury, so that the sole (radiological) exclusion of an ankle joint break cannot rule out an injury to the supporting apparatus.

Information about such an injury can ultimately be only found through a clinical examination undertaken by an experienced examiner. Magnetic resonance imaging (MRI) is often helpful. However, the appearance of the patient is decisive.

Therapy

The goal of the therapy is the restoration of the stable ankle joint-supporting apparatus. A sole immobilisation in an orthopaedic walker is sufficient for minor injuries, e.g. strained or incomplete rupture of the syndesmosis. For a complete rupture a non-operative therapy is not especially promising for the long-term. Depending on the severity of the injury, the sole insertion of an ankle joint-spanning adjusting screw is sufficient. Frequently however, a reconstruction of the ligament-apparatus is separately required. As long as the injury allows, minimally invasive procedures with modern long-term implants ('tight rope') which do not require the removal of metal are possible.

Aftercare

A significant advantage of the operative therapy alongside the anatomically exact reconstruction, is the careful mobilisation stability of the operated extremity, so that it does not lead to a stiffening of the ankle joint capsule. Firstly, a partial weight-bearing with under-arm crutches is post-operatively undertaken, which depending on the intra-operative report, should last up to 6 weeks. Before commencing with full weight-bearing, the removal of a possible adjusting screw (outpatient intervention in short anaesthesia) should occur, as there would be a danger that the material could break during sports activity.

Inability to work

The recommencement of light office work can occur after 1 to 2 weeks, so long as under-arm crutches are used.

Ability to do sport

After 6 weeks, initial medical machine training and subsequent competition training with an increase in weight-bearing can be restarted, so that unrestricted competition fitness can be achieved after the 12th week.