High Ankle Syndesmosis Disruption: All-Inside Arthroscopic Reduction and Internal Fixation

Abstract

Ankle syndesmotic injury, or high ankle sprain, has been shown to lead to chronic injury and long-term debilitation when undertreated or malreduced. Arthroscopic repair of ankle syndesmosis injury provides a novel therapeutic avenue to achieve adequate reduction and fixation of ankle syndesmosis injury while preventing unnecessary soft tissue trauma and shortening time to return to sport. We describe and illustrate one academic institution’s technique of arthroscopic repair of ankle syndesmosis injury as well as the benefits and pitfalls of such an approach. Syndesmosis arthroscopic reduction and internal fixation is a novel strategy addressing diagnosis and fixation while minimizing soft tissue disruption and allowing early return to activity. It allows direct visualization of a dynamic exam, enhancing the surgeon’s ability to accurately identify the injury pattern. Following diagnosis, the syndesmosis reduction maneuver and fixation are directly monitored arthroscopically helping to prevent iatrogenic malreduction, as the syndesmosis remains visible throughout. The addition of an all-inside anterior-inferior talofibular ligament reconstruction can augment syndesmosis stability if necessary.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.