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The Clinical Features of Ankle Syndesmosis Injuries: A General Review

Kellett, John J. MBBS

Clinical Journal of Sport Medicine: November 2011 - Volume 21 - Issue 6 - p 524–529
doi: 10.1097/JSM.0b013e318234be7d
General Review

Objective To review the research conclusions relating to clinical aspects of syndesmosis, the incidence and prognosis of syndesmosis injuries, and the effectiveness of the history and clinical examination to reliably diagnose ankle syndesmosis injury.

Data Sources Google Scholar search: Syndesmosis paired with incidence, prognosis, history, and examination in turn. There was no time limit for the search. Articles were selected by reading titles, abstracts, and the full article, if indicated, seeking original articles determining these clinical aspects of syndesmosis injuries. Further articles were derived from the references of the primary articles.

Main Results The prognosis for isolated syndesmosis injuries, including the time to functional recovery, is unknown. The incidence of acute syndesmosis injury in moderate to severe ankle injuries requiring imaging is of the order of 5%. Historical features and special clinical tests of syndesmosis injury have not been proven reliable by clinical studies using evidence-based diagnostic criteria. Acute local tenderness of the anterior inferior tibiofibular ligament will indicate significant syndesmosis injury in only approximately half of nonspecific ankle injuries.

Conclusions There is limited, evidence-based, standard, published literature from which to draw conclusions regarding the validity or reliability of various clinical special tests for syndesmosis injury. Literature assessing the incidence, prognosis, and clinical features is generally not based on definitively confirmed syndesmosis injuries, which is a critical aspect of evidence-based medicine before valid conclusions can be drawn.

Australian Institute of Sport, Bruce, Australian Capital Territory, Australian.

Corresponding Author: John J. Kellett, MBBS, FACSP, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia (

The author reports no conflicts of interest.

Received February 1, 2011

Accepted August 23, 2011

© 2011 Lippincott Williams & Wilkins, Inc.