title: Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains.
abstract: BACKGROUND
  Grade III syndesmosis sprains are usually treated with internal fixation. Limited information is available on early weightbearing and early return to activity after operative treatment for grade III syndesmosis sprains.
  
  
  OBJECTIVE
  Treatment of grade III syndesmosis sprains in intercollegiate athletes with internal fixation, early range of motion, and early weightbearing can lead to rapid return to sport with minimal complications and no ankle problems in midterm follow-up.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  We evaluated a consecutive series of intercollegiate athletes treated operatively with 4.5-mm cortical screw fixation for grade III syndesmosis sprains. At 1 week after surgery, patients were allowed to begin range of motion exercises, progressive weightbearing, and gradually return to full activity as tolerated. Outcome measures included time to return to full activity and, at final follow-up, the Sports Ankle Rating System scores.
  
  
  RESULTS
  Six male intercollegiate college athletes met the inclusion criteria for this study. The average time for return to full activity was 41 days (range, 32-48 days). There were no intraoperative complications or complications when resuming in-season sport activities with the screw in place. One screw broke during removal. At an average follow-up of 34.3 months, using the Sports Ankle Rating System, the average clinical rating score was 96.2, the average quality-of-life measure was 96.7, and the average single assessment numeric evaluation was 95.3. Radiographs at final follow-up showed no mortise widening or lateral talar subluxation. Two patients had mild degenerative changes on lateral radiographs with anterior tibial osteophytes.
  
  
  CONCLUSIONS
  In selective cases, athletes can return to full activity as early as 6 weeks after internal fixation of grade III syndesmosis sprains.
authors.affiliation: Department of Surgery, Division of Orthopaedic Surgery, Box 3615, Duke University Medical Center, Durham, NC 27710, USA. dean.taylor@duke.edu
authors.forename: Dean C
authors.initials: DC
authors.lastname: Taylor
authors.forename: Joachim J
authors.initials: JJ
authors.lastname: Tenuta
authors.forename: John M
authors.initials: JM
authors.lastname: Uhorchak
authors.forename: Robert A
authors.initials: RA
authors.lastname: Arciero
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D013180:Sprains and Strains / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome