Suture-Button Repair Improves Outcomes in Arthroscopically Diagnosed Chronic Syndesmotic Injury Despite Low Imaging Sensitivity
Abstract
Purpose: To evaluate patient-reported outcomes after arthroscopic suture-button repair of chronic isolated syndesmotic injuries and to compare the diagnostic sensitivity of standard imaging with arthroscopy.
Methods: Patients with chronic (≥3 months) syndesmotic injuries confirmed by arthroscopy (≥2 mm widening) who underwent suture-button repair between 2017 and 2021 were included. Exclusion criteria were ankle fractures, previous major surgery, or significant arthritis. Foot Function Index and Foot-and-Ankle Ability Measure scores were recorded preoperatively as part of routine clinical assessment and at final follow-up. The minimal clinically important difference was defined as 75% of preoperative standard deviation.
Results: Forty-one patients (43 ankles) were analyzed. Median age was 32 years (15-57 years), 63% were female, and time from injury to surgery was 1.7 years (0.25-25). Fifteen ankles (35%) received concomitant lateral suture-tape stabilization. Arthroscopic syndesmotic widening was 2-3 mm in 5%, 3-4 mm in 10%, >4 mm in 46%, and posterior in 38%. All 6 Foot Function Index and Foot-and-Ankle Ability Measure subscores improved significantly (P < .001), with 79% to 93% achieving minimal clinically important difference at a median 2.3-year follow-up (1.0-4.8). Sensitivity for syndesmotic pathology was 5% for radiographs and stress fluoroscopy, 22% for computed tomography, and 26% for magnetic resonance imaging.
Conclusions: Arthroscopic suture-button repair led to…
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