Diagnosis and Treatment of Syndesmotic Sprain by Ankle Arthroscopy

The syndesmotic sprains account for 1% to 11% of all ankle injuries. Good understanding of the mechanism of injury، physical examination، new imaging techniques and ankle arthroscopy help to improve assessment and management of high grade ankle sprains with a normal mortise relationship. Eleven patients (9 men، 2 women) with average age of 26 years (22-38 years)، who had syndesmotic sprain confirmed by ankle arthroscopy، were studied by the clinical symptoms and imaging assessments. The treatment results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean duration of injury was 9 months، and the follow up was 12 months Postoperatively، 7 ankles obtained excellent and 4 good results according to AOFAS score. Impingement of syndemotic scar tissue in the ankle joint was the main cause of persistent pain. These cases had no diastasis on the plain radiography and no obvious sign of instability during the ankle arthroscopy. In some cases، chondral softening and lesion were seen at the medial ridge of the Talus، which could be due to subtle instability and change in the ankle biomechanics. Syndesmosis ankle injury could produce chronic pain. Arthroscopic debridement، in the absence of ankle instability could be an effective tool.