title: Outcomes and Return to Activity After Operative Repair of Chronic Latent Syndesmotic Instability.
abstract: BACKGROUND
  This study is a retrospective review of prospectively gathered data determining the postoperative outcomes of patients who underwent operative treatment to address chronic syndesmotic instability.
  
  
  METHODS
  The cohort is composed of 19 individuals who elected to undergo operative treatment of chronic syndesmotic instability. The operative repair consisted of arthroscopic debridement in all cases with reduction and suture button fixation of those patients who had greater than 4 mm of syndesmotic diastasis on arthroscopic evaluation. All patients had a minimum of 24 months follow-up. This study retrospectively examined the prospectively gathered preoperative and postoperative outcome scores to include a Visual Analog Scale (VAS) pain score and an American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. In addition, patients were questioned on their ability to return to their preinjury level of activity and their ability to continue running sports. Fourteen patients returned their postoperative surveys.
  
  
  RESULTS
  Mean AOFAS scores improved significantly from 48 to 82.7 (P = .014). Mean VAS scores improved from 6.1 to 1.0 (P = .002). Overall, 86% (12/14) of patients were able to return to running and 79% (11/14) of patients were able to return to their preinjury level of sport. Preoperative and postoperative weight-bearing ankle radiographs were reviewed to evaluate the tibiofibular clear space and overlap. The clear space measured on anteroposterior (AP) radiographs decreased from 5.4 mm to 4.6 mm (P = .005), the clear space evaluated on the mortise radiograph decreased from 4.5 mm to 3.6 mm (P = .006), and the overlap measured on the AP radiograph increased from 5.7 mm to 6.9 mm (P = .019). All radiographs were measured by a board-certified musculoskeletal radiologist.
  
  
  CONCLUSIONS
  This study presents a treatment method that can be instituted at the time of diagnosis for syndesmotic injuries with greater than 4 mm of diastasis that were treated with debridement and stabilization. The results of this treatment technique are promising, with significant improvements in subjective outcome scores and a high rate of return to running sports.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Tripler Army Medical Center, Orthopaedic Clinic, Honolulu, HI, USA paul.m.ryan.mil@mail.mil.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ryan
authors.affiliation: Madigan Army Medical Center, Orthopaedic Clinic, Tacoma, WA, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Rodriguez
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy; D003646:Debridement; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D009984:Orthopedic Fixation Devices; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D000068958:Return to Sport; D064232:Visual Analog Scale
keywords: arthritis; biomechanics; outcome studies; sports; trauma