title: Arthroscopy-assisted repair of latent syndesmotic instability of the ankle.
abstract: OBJECTIVE
  The purpose of this study was to investigate the results of repair of latent ankle syndesmotic instability and widening by an arthroscopic and percutaneous approach.
  
  
  METHODS
  This case study series presents 6 patients who presented with latent syndesmotic instability after sustaining a rotational ankle injury. All 6 patients underwent arthroscopy-assisted repair and percutaneous fixation of the disrupted ankle mortise. Objective radiographic findings were obtained pre- and postoperatively as well as subjective patient outcomes using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
  
  
  RESULTS
  After a minimum of 2 years of follow-up, all patients had improvement of their AOFAS scores with a mean change of 32 (standard deviation, 7.0; P = .0001). The function component of the AOFAS score had the largest change from preoperative to postoperative status, with a value of 15 (P = .0009). Radiographic parameters were improved in all 6 patients. The reduction of the medial clear space was the most consistent finding, with a postoperative medial clear space ranging from 2.6 to 3.5 mm (mean change, 3.2 mm; P = .0002).
  
  
  CONCLUSIONS
  Our small series, with a minimum follow-up of 24 months, suggests that arthroscopy-assisted treatment of latent syndesmotic instability is an effective method. The primary outcome measure of AOFAS scores showed statistically significant improvement in pain and function at final follow-up. Alignment of the ankle did not exhibit statistically significant changes. Both of the secondary radiographic outcome measures were statistically improved at final follow-up.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente Medical Center, San Francisco, California 94118, USA. Jmfoot@aol.com
authors.forename: John M
authors.initials: JM
authors.lastname: Schuberth
authors.forename: Meagan M
authors.initials: MM
authors.lastname: Jennings
authors.forename: Alex C
authors.initials: AC
authors.lastname: Lau
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D018771:Arthralgia / Q000209:etiology / Q000503:physiopathology; D001175:Arthrography; D001182:Arthroscopy; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D016896:Treatment Outcome