Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis.
OBJECTIVE
The purpose of this study was to investigate the clinical results of anatomical reconstruction of anterior inferior tibiofibular ligament (AITFL) for the chronic tibiofibular syndesmotic disruption after typical pronation external rotation (PER) stage 4 injury.


METHODS
Six consecutive patients with chronic syndesmotic disruption after PER stage 4 injury were surgically treated. In all six patients, preoperative CT revealed remarkable opening of only the anterior part of the distal tibiofibular joint, and all six underwent anatomical reconstruction of the AITFL using autogenous gracilis tendon after confirmation of preserved tension of the posterior inferior tibiofibular ligament through intra-operative arthroscopic examination. Clinical evaluation was made using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS)and visual analogue scale (VAS) just before reconstructive surgery and at the most recent follow-up (median: 38 months, range, 31-50).


RESULTS
Median AOFAS score improved from preoperative 53 points (range, 47-74) to postoperative 95 points (range, 90-100) (P < 0.05), and median VAS score improved from preoperative 95 points (range, 55-100) to postoperative 4 points (range, 0-14) (P < 0.05).


CONCLUSIONS
The procedure, which can achieve anatomical reconstruction of the AITFL easily, seems to be one possible treatment for chronic disruption of the distal tibiofibular syndesmosis after PER stage 4 injury including avulsion fracture of the posterior malleolus, which is most common in this type of injury.
Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.
Youichi
Y
Yasui
Masato
M
Takao
Wataru
W
Miyamoto
Ken
K
Innami
Takashi
T
Matsushita
D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods; D001863:Bone Screws; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005360:Fibula / Q000293:injuries / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult