Tibiocalcaneal arthrodesis: a comparison of anterior approach and transfibular approach / Artrodese tibiocalcaneana: comparação entre abordagem anterior e a abordagem transfibular

ABSTRACT Objective: The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods: Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result: The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions: A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos e as complicações de pacientes submetidos à artrodese de tornozelo realizada por abordagem transfibular e abordagem anterior em fase terminal de osteoartrite de tornozelo. Métodos: Foram incluídos 41 pacientes atendidos entre 2016 e 2022 que satisfizeram os critérios de inclusão para esta análise comparativa retrospectiva. Destes, 19 incluídos no grupo de abordagem anterior e 22 no grupo de abordagem transfibular. A média de idade foi de 58,9 anos. Os dados coletados incluíram o índice de massa corporal (IMC), a escala de retropé da American Orthopedic Foot and Ankle Society (AOFAS), o escore da escala visual analógica (EVA), assim como a presença de diabetes, tabagismo, tempo de fusão, não união, taxa de união, ângulo tibiotalar coronal pré e pós-operatório e complicações. Resultado: O tempo médio de consolidação óssea foi de 14,3 semanas (variação de 11 a 17 semanas) no grupo de abordagem anterior e 11,3 semanas no grupo de abordagem transfibular. Foi encontrada diferença estatisticamente significante entre os dois grupos. A consolidação não ocorreu em um caso no grupo de abordagem transfibular e em três casos no grupo de abordagem anterior. Não houve diferença significativa na taxa de não consolidação entre os dois grupos (p = 0,321). Os escores nas escalas EVA e AOFAS dos dois grupos foram semelhantes, não sendo encontradas diferenças significativas (p = 0,491, p = 0,448, p = 0,146, p = 0,073, p = 0,173, p = 0,506, respectivamente). Conclusões: Uma artrodese estável e firme do tornozelo e um pé plantígrado podem ser obtidos tanto com a abordagem transfibular quanto com a técnica de abordagem anterior. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Optimization method for ankle strength training during exercise / Método de otimização no treino de força do tornozelo durante o exercício / Método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio

ABSTRACT Introduction Good ankle joint strength is a precondition for high-quality exercise and is an important factor in preventing joint injuries. Objective Explore the method of optimizing ankle strength training during exercise. Methods 40 volunteers were selected and randomly divided into an experimental group and a control group. The 20 athletes in the experimental group were trained three times a week for six weeks using a control variable method, while the control group performed only professional daily physical training. Pre-training and post-training methods were used to collect and investigate the data regarding the effect of strength training on the ankle joint and its impact on skill and strength tests submitted to the athletes. Results Ankle strength training can improve ankle muscle strength and athletes' ability to run and jump (P > 0.05). Conclusion Ankle joint strength training may improve athletes' baseline sporting ability, improve ankle joint muscle strength, reduce the likelihood of joint injuries, and contribute to improved outcomes of various abilities, meriting further study and replication. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução A boa força articular do tornozelo é uma pré-condição para exercícios físicos de alta qualidade além de ser um fator importante na prevenção de lesões articulares. Objetivo Explorar o método de otimização do treino de força do tornozelo durante o exercício físico. Métodos 40 voluntários foram selecionados e aleatoriamente divididos em grupo experimental e grupo de controle. Os 20 atletas do grupo experimental foram treinados três vezes por semana durante 6 semanas usando um método de variáveis de controle enquanto o grupo controle efetuou apenas o treinamento físico diário profissional. Foram utilizados métodos pré-treino e pós-treino para coleta e investigação dos dados quanto ao efeito do treinamento de força sob a articulação do tornozelo e seu impacto em testes de habilidade e força submetidos aos atletas. Resultados O treinamento de força do tornozelo pode melhorar a força muscular do tornozelo e melhorar a capacidade dos atletas de correr e saltar (P > 0,05). Conclusão O treino de força articular do tornozelo pode melhorar a capacidade esportiva basal dos atletas, melhorar a força muscular da articulação do tornozelo, reduzir a probabilidade de lesões articulares e contribuir na melhoria dos resultados de várias habilidades, merecendo maiores estudos e replicação. Nível de evidência II; Estudos terapêuticos - investigação dos desfechos do tratamento.

RESUMEN Introducción Una buena resistencia de la articulación del tobillo es una condición previa para la realización de ejercicio físico de alta calidad y un factor importante en la prevención de lesiones articulares. Objetivo Explorar el método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio. Métodos Se seleccionaron 40 voluntarios y se dividieron aleatoriamente en grupo experimental y grupo de control. Los 20 atletas del grupo experimental se entrenaron tres veces a la semana durante 6 semanas con un método variable de control, mientras que el grupo de control sólo realizó un entrenamiento físico profesional diario. Se utilizaron métodos de pre-entrenamiento y post-entrenamiento para recoger e investigar los datos relativos al efecto del entrenamiento de fuerza bajo la articulación del tobillo y su impacto en las pruebas de habilidad y fuerza a las que se sometieron los atletas. Resultados El entrenamiento de la fuerza del tobillo puede mejorar la fuerza muscular del tobillo y mejorar la capacidad de los atletas para correr y saltar (P > 0,05). Conclusión El entrenamiento de la fuerza de la articulación del tobillo puede mejorar la capacidad deportiva de base de los atletas, mejorar la fuerza muscular de la articulación del tobillo, reducir la probabilidad de lesiones articulares y contribuir a mejorar los resultados de varias habilidades, mereciendo más estudios y réplicas. Nivel de evidencia II; Estudios terapêuticos - investigación de los resultados del tratamiento.

Isokinetic muscle strength characteristics of lower limb joints in long jumpers / Características da força muscular isocinética das articulações dos membros inferiores dos saltadores de salto em distância / Características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud

ABSTRACT Introduction: Joint strength of the lower limbs plays a decisive role in the competitive ability of long jumpers. Special strength training based on science and targeted at the strength of the lower limb joints is an essential topic for long jumpers. Objective: To analyze isokinetic muscle strength characteristics of lower limb joints in long jumpers. Methods: Voluntary jumpers were submitted to isokinetic concentric contraction tests of the lower limbs and hip joints. We also analyzed the effect of strength training on lower limb joint injury. Results: The knee muscles of the athletes have reduced eccentric contractility. The ankle of the athlete has the most vulnerable joint to injuries in the sport. Conclusion: The explosive force and eccentric contractility of long jumpers' lower limb extensor muscles have the most significant impact on joint thrust and extension speed. Athletes need muscle strength training to develop isokinetic muscle strength. This can effectively prevent injury to lower extremity joint movements. The research findings of this paper can provide a specific theoretical basis for formulating scientific training for long jumpers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A força conjunta dos membros inferiores desempenha um papel decisivo na capacidade competitiva nos saltadores de salto em distância. O treinamento de força especial baseado na ciência e direcionado para a força das articulações dos membros inferiores é um tópico essencial para os saltadores. Objetivo: Analisar as características de força muscular isocinética das articulações dos membros inferiores em saltadores de salto em distância. Métodos: Saltadores voluntários foram submetidos à testes de contração concêntrica isocinética dos membros inferiores e articulação do quadril. Efetuou-se também a análise do efeito do treinamento de força na lesão das articulações dos membros inferiores. Resultados: Os músculos dos joelhos dos atletas têm uma contratilidade excêntrica reduzida. O tornozelo dos atletas possui a articulação mais vulnerável a lesões no esporte. Conclusão: A força de explosão e a capacidade de contração excêntrica dos músculos extensores dos membros inferiores dos saltadores de salto longo têm o impacto mais significativo no empuxo das articulações e na velocidade de extensão. Os atletas precisam de treinamento de força muscular para desenvolver a força muscular isocinética. Isto pode efetivamente evitar lesões nos movimentos das extremidades inferiores das articulações. Os resultados da pesquisa deste trabalho podem fornecer uma base teórica específica para a formulação do treinamento científico para os saltadores de salto longo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La fuerza articular de los miembros inferiores desempeña un papel decisivo en la capacidad competitiva de los saltadores de longitud. El entrenamiento de fuerza especial basado en la ciencia y dirigido a la fuerza de las articulaciones de los miembros inferiores es un tema esencial para los saltadores. Objetivo: Analizar las características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud. Métodos: Los saltadores voluntarios fueron sometidos a pruebas de contracción concéntrica isocinética de los miembros inferiores y de las articulaciones de la cadera. También se realizó un análisis del efecto del entrenamiento de fuerza en las lesiones de las articulaciones de los miembros inferiores. Resultados: Los músculos de la rodilla de los atletas tienen una contractilidad excéntrica reducida. El tobillo de los atletas tiene la articulación más vulnerable a las lesiones en el deporte. Conclusión: La fuerza de explosión y la contractilidad excéntrica de los músculos extensores de las extremidades inferiores de los saltadores de longitud tienen el impacto más significativo en el empuje articular y la velocidad de extensión. Los atletas necesitan entrenar la fuerza muscular para desarrollar la fuerza muscular isocinética. Esto puede prevenir eficazmente las lesiones en los movimientos de las articulaciones de las extremidades inferiores. Los resultados de la investigación de este trabajo pueden proporcionar una base teórica específica para la formulación del entrenamiento científico de los saltadores de longitud. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Consistency study of FRACTURE sequence and CT in evaluating bone changes of knee and ankle / 中华放射学杂志

Objective:To explore the consistency of MRI fast field echo resembling a CT using restricted echo-spacing (FRACTURE) and CT in the evaluation of knee and ankle bone changes.Methods:From November 2020 to November 2021, seventeen patients who underwent CT and MRI FRACTURE examinations of knee joint or ankle joint in the First Affiliated Hospital of Dalian Medical University were retrospectively collected, including 14 patients with knee joint examinations and 3 patients with ankle joint examinations. According to the number of joint components, 80 components were included, including 14 for femur and patella, 17 for tibia and fibula, and 3 for talus, scaphoid, medial cuneiform, medial cuneiform, lateral cuneiform and calcaneus, respectively. The fracture, hyperosteogeny, and bone destruction of the joint bones were evaluated by two observers using CT and FRACTURE images, respectively. Kappa test was used to analyze the consistency of CT and FRACTURE images between observers in the evaluation of joint bone lesions.Results:The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by CT and FRACTURE images were 0.925 (0.823-1.027), 0.905 (0.799-1.011) and 0.895(0.752-1.038) respectively for observer 1, and were 0.963 (0.892-1.034), 0.933 (0.843-1.023) and 0.886 (0.731-1.041) respectively for observer 2. The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by observers 1 and 2 via CT images were 1.000 (1.000-1.000), 0.937(0.851-1.023) and 0.945 (0.839-1.051) respectively, and that by FRACTURE images were 0.962 (0.888-1.036), 0.966 (0.899-1.033) and 0.836 (0.656-1.016) respectively.Conclusion:For the evaluation of fracture, hyperosteogeny, and bone destruction of knee joint and ankle joint, MRI FRACTURE sequence is highly consistent with CT.

Current research on injury to the distal tibiofibular syndesmosis and prospects of its treatment / 中华创伤骨科杂志

Among ankle injuries, the injury to the distal tibiofibular syndesmosis is common and likely neglected. The stability of the distal tibiofibular syndesmosis is related to the depth of the fibular notch. In imaging diagnosis, X-ray examination cannot be used for a definite diagnosis of the injury to the distal tibiofibular syndesmosis. For diagnosis of the distal tibiofibular separation>3 mm, CT scan can be accurate but is not sensitive enough for a separation<1 mm while MRI is more sensitive in diagnosis of the injury. Arthroscopy has gradually been used as the "gold standard" in diagnosis of the injury to the distal tibiofibular syndesmosis due to its advantage of direct vision. The distal tibiofibular separation occurs in the injuries of pronation external rotation Ⅳ°, supination external rotation Ⅲ° and Ⅳ°, and pronation abduction Ⅱ° and Ⅲ° by the Lange-Hansen classification. Most patients with simple stable injury to the distal tibiofibular syndesmosis may have a good prognosis after nonoperative treatment. Surgical anatomic reduction and maintenance of stability of the distal tibiofibular syndesmosis are the basic management principles for unstable distal tibiofibular syndesmosis or the injury to the distal tibiofibular syndesmosis combined with ankle fracture. Screw fixation is the most commonly used in the surgical treatment of the injury. Elastic fixation has the advantages of maintaining the biological characteristics of the distal tibiofibular syndesmosis fretting joint, better reduction fault tolerance, and lower rates of complications and long-term reduction loss. The angle of nail placement is the key to maintaining good reduction of the distal tibiofibular syndesmosis, but there has been little description of the specific methods to ensure the theoretical angle of nail placement in practice. This article also reviews the prospects of the future treatment of the injury to the distal tibiofibular syndesmosis.

Distal tibial spiral fracture and ankle injury / 中华创伤骨科杂志

Objective:To characterize the injury to the ipsilateral ankle joint after low energy spiral fracture of the distal tibia.Methods:A retrospective study was conducted to analyze the 80 patients with distal tibial spiral fracture who had been treated at Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University from March 2010 to March 2021. There were 61 males and 19 females with an age of (43.5±12.5) years. Their mean follow-up time was 67.0 (38.5, 90.0) months. All patients underwent preoperative X-ray examination, 64 ones preoperative CT examination, and 30 ones preoperative MRI examination. Of the 80 patients, 3 received conservative treatment with plaster external fixation, 3 closed reduction and intramedullary nail fixation, and 74 plate fixation. Statistically analyzed were incidence of posterior malleolus fracture, characteristics of posterior malleolus fracture lines, normal matching rate of the ipsilateral ankle joint, positive rate of intraoperative Cotton test or stress external rotation test of ipsilateral ankle joint, positive rates of passive pronation-external rotation and supination-external rotation stress tests during follow-up, incidences of short-term ankle pain (≤2 years) and medium-long term pain (>2 years) after operation, injuries to the anterior inferior tibiofibular ligament, the deep medial malleolus deltoid ligament and the posterior malleolus, and incidence of ankle injury.Results:The diagnostic rate for posterior malleolus fracture was 16.3% (13/80) on X-ray film, 60.9% (39/64) on CT and 76.7% (23/30) on MRI. 74.5% (35/47) of the posterior malleolus fracture lines opened on the lateral side. The normal matching rate of the ipsilateral ankle joint was 96.3% (77/80). The positive rates of intraoperative Cotton test and stress external rotation test were 34.8% (8/23) and 7.1% (1/14), respectively. The positive rates of passive pronation-external rotation and supination-external rotation stress tests during follow-up were 46.2% (12/26) and 34.6% (9/26). The incidences of postoperative short term (≤2 years) and medium-long term (>2 years) ankle pain were 37.7% (29/77) and 20.8% (16/77). MRI examination showed that the rates of injury to the anterior inferior tibiofibular ligament, deep medial malleolus deltoid ligament and posterior malleolus were 80.0% (24/30), 80.0% (24/30) and 76.7% (23/30). The incidence of ankle injury was 88.8% (71/80).Conclusions:It is highly probable that spiral fracture of the distal tibia is complicated with ipsilateral ankle injury. The medial malleolus, lateral malleolus, and posterior malleolus are prone to the following hidden injuries while the ankle joint is normally matched in the most cases: injury to the deep deltoid ligament in different degrees, rupture of the inferior tibiofibular anterior ligament and posterior malleolus fracture. Therefore, the ankle injury is likely to be missed in diagnosis. The secondary torsion injuries to the pronation-external rotation and supination-external rotation at the leg are likely to cause ipsilateral ankle injury.

Arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement in the treatment of chronic lateral ankle instability concomitant with fibular tendinitis / 中华创伤杂志

Objective:To compare the efficacies of arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement in the treatment of chronic lateral ankle instability (CLAI) concomitant with fibular tendinitis.Methods:A retrospective cohort analysis was conducted on the clinical data of 31 patients with CLAI concomitant with fibular tendinitis, who were treated in Beijing Tongren Hospital, Capital Medical University between March 2019 and December 2021. The patients included 17 males and 14 females, aged 16-57 years [(32.8±9.6)years]. The anterior drawer test and talar tilt test were positive in all patients preoperatively. Diagnosis was confirmed by physical examination and MRI, and calcaneofibular ligament rupture was excluded. Eleven patients received arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement (modified Brostr?m procedure+tendon debridement group), and 20 underwent pure arthroscopic modified Brostr?m procedure (modified Brostr?m procedure group). The operation time, intraoperative blood loss and length of hospital stay were documented. The visual analogue score (VAS) in peroneal tendon area was assessed before operation and at postoperative 2, 6 and 12 weeks. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle outcome score (FAOS) were assessed before operation and at postoperative 6 and 12 weeks. The anterior drawer test was performed at the last follow-up. The foot and ankle ability measure (FAAM) score was assessed before operation and at the last follow-up. Postoperative wound healing and complications were also observed.Results:All the patients were followed up for 4-19 months [(11.3±3.5)months]. The operation time was (66.0±4.2)minutes in the modified Brostr?m procedure+tendon debridement group, which was significantly longer than (61.5±3.4)minutes in the modified Brostr?m procedure group ( P<0.05). There was no significant difference in intraoperative blood loss or length of hospital stay between the two groups (all P>0.05). Compared with the preoperation, the value of VAS was significantly lowered, and the values of AOFAS ankle-hindfoot score, FAOS and FAAM score were significantly increased at different postoperative timepoints (all P<0.01). No significant differences in the values of VAS, AOFAS ankle-hindfoot score, FAOS or FAAM score were seen between the two groups before operation (all P>0.05). The value of VAS was 3.0(3.0, 4.0) points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 4.0(4.0, 4.0)points in the modified Brostr?m procedure group at 2 weeks postoperatively ( P<0.05). The value of VAS was 2.0(1.0, 3.0)points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 3.0(2.3, 3.0)points in the modified Brostr?m procedure group at 6 weeks postoperatively ( P<0.05). At 12 weeks postoperatively, there was no significant difference in the value of VAS between the two groups ( P>0.05). There were no significant differences in the values of AOFAS ankle-hindfoot score and FAOS between the two groups at 6 or 12 weeks postoperatively (all P>0.05). The anterior drawer test was negative in all patients at the last follow-up. No significant difference was seen in the value of FAAM score between the two groups at the last follow-up ( P>0.05). All incisions were healed well in the first stage after operation, without the occurrence of joint infection, impaired joint motion, nerve injury or deep vein thrombosis. Conclusions:Arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement can both improve the foot function in CLAI patients concomitant with fibular tendinitis. However, the combined treatment allows for early pain relief, without increasing the risk of complications, and can therefore contribute to a faster postoperative recovery.

Modified arthroscopic Brostr?m procedure for the treatment of chronic ankle instability combined with multiple ligament laxity / 中华创伤杂志

Objective:To investigate the effectiveness of modified arthroscopic Brostr?m procedure for the treatment of chronic ankle instability combined with multiple ligament laxity.Methods:A retrospective case series study was used to analyze the clinical data of 26 patients with chronic ankle instability combined with multiple ligament laxity treated at Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2016 to December 2020, including 10 males and 16 females; aged 18-48 years [(27.5±7.1)years]. All patients underwent arthroscopic repair of the anterior talofibular ligament (ATFL) by the modified Brostr?m procedure. Healing of surgical incisions was observed after operation. The change of talus tilt angle for ankle stability evaluation, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score for ankle function evaluation, and the visual analogue score (VAS) for pain evaluation were assessed before operation, at 3 months postoperatively and at the last follow-up. Complications were observed.Results:All patients were followed up for 18-47 months [(25.3±8.5)months]. All surgical incisions were healed at stage I. The talus tilt angle was decreased from preoperative (15.6±4.7)° to (4.1±1.3)° and (3.5±0.9)° at 3 months postoperatively and at the last follow-up (all P<0.01). The AOFAS ankle-hindfoot score was improved from preoperative (65.8±14.5)points to (86.5±5.6)points and (93.4±4.2)points at 3 months postoperatively and at the final follow-up (all P<0.01). The VAS was decreased from preoperative 3.0 (2.0, 4.0)points to 1.5 (0.0, 2.0)points and 1.0 (0.0, 1.2)points at 3 months postoperatively and at the last follow-up (all P<0.01). Significantly higher AOFAS ankle-hindfoot score and lower VAS were found at the final follow-up when compared with the scores at 3 months postoperatively (all P<0.05). One patient developed superficial peroneal nerve injury, which was recovered spontaneously without special treatment. Conclusion:For chronic ankle instability combined with multiple ligament laxity, the modified arthroscopic Brostr?m procedure has advantages of improved ankle stability, good ankle function recovery, obvious pain relief and less postoperative complications.

Multi-slice CT imaging characteristics of distal tibiofibular syndesmosis in healthy adults / 中华创伤杂志

Objective:To measure the morphological parameters of distal tibiofibular syndesmosis in healthy adults using multi-slice CT (MSCT) so as to provide a reference for the diagnosis of distal tibiofibular syndesmosis injury.Methods:The ankle MSCT imaging data in 110 normal adults were retrieved from the image report database of Cangzhou People′s Hospital from May 2019 to May 2021, including 56 males and 54 females; aged 18-60 years [(38.2±11.0)years]. There were 51 patients with imaging on the right ankle and 59 on the left ankle. Picture archiving and communication system (PACS) was used to measure parameters at 10 mm above the articular surface of the distal tibia on MSCT, including the anterior tibiofibular space (L1), posterior tibiofibular space (L2), middle tibiofibular space (L3), depth of fibula in notch (L4), distance of anterior tibiofibular edge (L5), distance of posterior tibiofibular edge (L6), anterior tibiofibular syndesmosis angle (A1), and fibular rotation angle (A2), and the measurements were compared by sex, age and side. The positive rate of "tibiofibular line" was observed. The morphological classification of distal tibiofibular syndesmosis was performed.Results:There was no significant difference in L1-L6, A1 and A2 among different age and side (all P>0.05). No significant difference was found in L4, L5, A1 and A2 between males and females ( P>0.05), but L1, L2, L3 and L6 were larger in males than in females ( P<0.05 or 0.01). The positive rate of "tibiofibular line" was 80.4% (45/56) in males compared to 74.1% (40/54) in females ( P>0.05), 77.2% (44/57) in the youth compared to 77.4% (41/53) in the middle-aged, and 78.0% (46/59) in the left ankle compared to 76.5% (39/51) in the right ankle (all P>0.05). Morphological classification of distal tibiofibular syndesmosis was crescent in 61 patients (55.5%), trapezoid in 14 (12.7%), I-shaped in 3 (2.7%), M-shaped in 17 (15.5%), V-shaped in 10 (9.1%), Г-shaped in 5 (4.5%). Conclusions:When L1, L2, L3 and L6 are used as references in the diagnosis of adult distal tibiofibular syndesmosis injury, gender factors rather than age or side factors should be considered. Males have wider distal tibiofibular space than females, with the fibula more forward. The "tibiofibular line" has a high positive rate and is not affected by gender, age or sides, providing a new idea for the diagnosis of distal tibiofibular syndesmosis injury and anatomical reduction. There are many variations in the morphology of distal tibiofibular syndesmosis, so it is easy to be misdiagnosed as the separation of distal tibiofibular syndesmosis on X-ray, which should be noted.

Effects of platelet-rich plasma injection therapy combined with muscle strength training on ankle function in patients with traumatic ankle arthritis / 中国基层医药

Objective:To investigate the effects of platelet-rich plasma injection therapy combined with muscle strength training on ankle function in patients with traumatic ankle arthritis.Methods:The clinical data of 98 patients with traumatic ankle arthritis admitted to The 906 Hospital of PLA Joint Logistics Support Force from January 2020 to January 2021 were retrospectively analyzed. These patients were grouped according to different treatment methods. Patients in the control group ( n = 31) received muscle strength training. Patients in the sodium hyaluronate group ( n = 33) received muscle strength training and intraarticular injection of sodium hyaluronate. Patients in the platelet-rich plasma group ( n = 34) received muscle strength training and intraarticular injection of platelet-rich plasma. Ankle function, excellent and good recovery rate, and muscle strength were compared among the three groups before and after treatment. Results:After treatment, the American Orthopaedic Foot & Ankle Society scores in the control, sodium hyaluronate, and platelet-rich plasma groups were (38.22 ± 3.02) points, (41.55 ± 2.04) points, and (44.22 ± 2.69) points respectively, pain scores were (26.98 ± 4.05) points, (31.22 ± 4.20) points, and (34.44 ± 2.44) points respectively, on-line scores were (6.11 ± 1.41) points, (7.39 ± 1.06) points, and (8.25 ± 1.03) points respectively. There were significant differences in the American Orthopaedic Foot & Ankle Society scores, pain scores, and online scores among the three groups ( F = 43.01, 34.30, 27.21, all P < 0.001). In the control, sodium hyaluronate, and platelet-rich plasma groups, dorsiflexor strength was (103.66 ± 10.69) N·m, (129.33 ± 12.37) N·m, (133.69 ± 10.58) N·m, respectively, plantar flexor strength was (121.36 ± 15.69) N·m, (140.23 ± 14.66) N·m, (144.55±13.55) N·m, respectively, ankle function score was (84.22 ± 2.69) points, (88.55 ± 3.01) points, (92.56 ± 3.55) points, respectively. There were significant differences in dorsiflexor strength, plantar flexor strength, and ankle function score among the three groups ( F = 66.37, 22.70, 58.05, all P < 0.001). There was no difference in adverse reactions among the three groups ( Z = 1.05, P > 0.05). Conclusion:Platelet-rich plasma injection therapy combined with muscle strength training is highly effective on traumatic ankle arthritis and can markedly improve ankle function and prognosis.

Impact of Previous Ankle Injuries on Professional Footballers' Preseason Functional Ankle Assessment

@#Introduction: Football is the most popular sport and is widely played around the globe, with approximately 400 million players in 208 countries. Lower extremity injuries showed the highest incidence, with ankle injuries being the most prevalent after hip and knee injuries. The purpose of this study was to describe the characteristics of the players who reported previous ankle injuries during pre-competition medical assessment (PCMA) during the 2022 seasons of the Malaysian professional club. In addition, the study also investigated the effect of previous injuries on current ankle function. Materials and methodsː This was a retrospective crosssectional study using secondary data from the preseason PCMA data from a professional club that competed in Malaysia. The ankle range of motion, anterior drawer test, and functional ankle assessments including the Biodex athlete single leg stability test and ankle joint muscle strength were performed during the PCMA. Results: A total of 45 footballers reported previous history of ankle injuries to the left (n=9), right (n=20), or both ankles (n=16). Footballers with prior ankle injuries exhibited significantly less ankle inversion (p = 0.008) and a larger proportion of positive ADT tests in the injured ankle (x² (1, N=90) =7.76, p=0.005) compared to the non-injured side. there was no significant difference in other ankle range of motion, ankle stability index, or ankle muscular strength between previously injured and uninjured ankles. Conclusionsː During preseason screening, half of the footballers in this study reported previous history of ankle injury, putting them at risk of having future ankle injuries. Aside from inversion and the anterior drawer test, no significant differences in range of motion, stability index, or muscle strength were discovered. However, as injury causation is multifactorial, preventive measures should be taken to reduce the risk of injury.

Taping can relieve chronic ankle instability among basketball players / 中华物理医学与康复杂志

Objective:To observe the effect of taping on the kinematic characteristics of the ankle joint during forward and lateral jumps by male basketball players with chronic ankle instability (CAI).Methods:A Vicon 3D motion capture system and a Kistler 3D ergometer were used to collect data describing the landing data with or without taping from forward and lateral jumps of 29 male basketball players with CAI. The landing data included the dorsiflexion and plantarflexion angles, valgus and inversion angles and external and internal rotation angles. Dorsiflexion or plantarflexion angular velocity was also recorded along with valgus or inversion angular velocity and external or internal rotation angular velocity 200ms, 150ms, 100ms and 50ms before and after touchdown. The data obtained were modeled using three-dimensional motion analysis software, and then analyzed.Results:Taping reduced the ankle plantarflexion in landing from a forward jump by 3.27° 50ms before landing and by 2.70° at touchdown. The ankle inversion angle was reduced 2.13° 50ms before touchdown, while the angle of external rotation decreased by 2.59° 200ms before touchdown and 2.17° 150ms before. Moreover, the angle of external rotation 100ms after landing was reduced by a significant 1.59° compared with that without taping. In lateral jumps taping reduced the average ankle plantarflexion angle by 1.94° 50ms before landing and 3.23° at touchdown compared with no taping. Ankle inversion was reduced significantly by 2.86° 50ms before landing and by 2.87° at touchdown. External rotation was a significant 0.93° less 200ms before landing and 2.36° smaller 150ms before touchdown. In the forward jump landing, taping reduced the average angular velocity of ankle dorsiflexion on landing by a significant 58.5°/s and by 28.39°/s 100ms later. In the lateral jump landings the average ankle dorsiflexion velocity decreased by significant 20.5°/s with taping, but the valgus velocity increased by 49.7°/s compared with no taping. However, 50ms after touchdown the speed of external rotation with taping was 30.3°/s slower than without taping.Conclusions:Ankle taping can modify ankle rotation angles and angular velocities during landing from jumps. This is particularly helpful for basketball players with CAI.

Application of newly designed modular hinged ankle prosthesis in the reconstruction of defect after surgical treatment of malignant tumor at the distal tibia / 中华骨科杂志

Objective:To investigate the outcome of surgical treatment of malignant tumor at the distal tibial after reconstruction with modular hinged ankle prosthesis.Methods:The data of 9 patients with malignant tumor at the distal tibia at Musculoskeletal Tumor Center of PKUPH from June 2020 to November 2021 were analyzed retrospectively. They were male patients with age of 17 (14, 24) years (range 11-56 years). There were five tumors at the left sides and four at the right sides. There were eight patients with osteosarcoma who received the neo-chemotherapy. Among eight osteosarcomas, one was Enneking IIA and seven Enneking IIB. Furthermore, there was only one patient with renal carcinama and with solitary metastatic lesion at the distal tibia. After the resection of tumor at the distal tibia, talus cartilage was removed and talus component was fixed by lag screws. The proper tibia component was used to restore the defect of tibia and the reduction of tibia and talus components were performed. The following clinical data were collected: baseline demographic features, surgical and follow-up data. The baseline demographic features included gender, age, side, lung or/and other metastasis at initial diagnosis, Enneking stage or systematic progression for renal carcinama, histological type. The surgical data included: surgery time, blood loss, length of bone involved by the tumor, prosthesis type. Monitoring data was also recorded: complications (ankle pain when loading, talar collapse, component loosing, infection and wound dehiscence), local recurrence, pulmonary and systematic metastasis, radiological image and the function at the last follow-up (MSTS and VAS evaluation).Results:Among these nine patients, the average blood loss was 245.6±103.9 ml (range 100-400 ml) and the mean surgery time was 178.9±56.9 mins (range 120-300 min). No patient was lost during the follow-up period and the average follow-up was 21.4±5.6 months (range 12.5-27.2 months). The excision length of tibia was 14 (11, 17) cm (range 11-28 cm). There were one case with 2# prosthetic base, three cases with 3# and five cases with 4#. Five had cement fixation of prosthetic stem and four had the pressing fixation. No pulmonary and other organ metastasis occurred among eight patients with osteosarcoma and one patient with distal tibia matastasis of renal carcinama. One patient with OShad the local recurrence and received the resection. One sustained the deep infection after four months and received the removal of prosthesis and spacer implant. At the final follow-up, except one with deep infection and receiving the removal of prosthesis and spacer implant, eight patients were assessed for the function. The average MSTS was 97.1%±3.3% (range 93%-100%). The VAS of all patients was 0. One patient with prosthesis removal had no functional evaluation. At the final follow-up, all patients walked without crutch. No breakage and loosening of prosthetic stem, talar collapse, prosthetic sinking and ankle pain occurred at the final follow-up.Conclusion:The early satisfactory outcome can be obtained for patients with segmental defect after resection of malignant tumor at the distal tibia, who received the newly designed modular hinged ankle prosthesis. Meanwhile, it's worth promoting in the reconstruction of large segmental defect at the distal tibia.

A new 3D-printed ankle fusion prosthesis for the treatment of osteosarcoma in the distal tibia: a case report / 中华骨科杂志

To report the short-term clinical outcome of three cases of distal tibial osteosarcoma treated with a novel 3D-printed ankle fusion prosthesis for limb preservation. The patients were admitted to the Department of Bone Tumor, Shanghai General Hospital from January 2020 to June 2021, with one male and two female cases, aged 18, 12, and 14 years, respectively, all diagnosed with distal tibial osteosarcoma (Ennecking stage IIb). A new self-designed ankle fusion prosthesis was used to perform osteosarcoma resection and prosthetic reconstruction of the distal tibia. The operation time, blood loss, postoperative American Orthopedic Foot and Ankle Society Score (AOFAS) and ankle range of motion were recorded. All the 3 patients successfully completed the operation and were followed up for 22 months, 18 months and 12 months, respectively. The operation time was 140 min, 110 min and 200 min, and the blood loss was 200 ml, 200 ml and 350 ml, respectively. At the last follow-up, the AOFAS were 86, 90 and 95 points, and the range of motion of ankle flexion and extension were 30°, 15° and 30°. There was no local recurrence or lung metastasis at the last follow-up. The novel 3D-printed ankle fusion prosthesis in the distal tibia is safe and effective for the reconstruction of bone defects after resection of osteosarcoma in the distal tibia, and the early postoperative function is satisfactory.

Research progress on patient-reported outcomes in foot and ankle surgery / 中华骨科杂志

Patient-reported outcomes (PROs) are information that comes directly from any aspect of a patient's own health status. The traditional patient-reported outcome measures (PROMs) used in foot and ankle surgery include the American Association of Foot and Ankle Surgery series scale, the visual analogue scale, the medical outcomes study 36-item short form of health survey (SF-36), the foot and ankle outcome scale and the medical outcome study 12-item short form of health survey (SF-12). In the process of use, these PROMs can not accurately reflect the patient's feelings because of the subjective influence of doctors, only responding to specific diseases or general health conditions, and the test fatigue caused by too long questionnaires, which ultimately affect the reliability and validity of the results. The scales of the patient-reported outcome measurement information system (PROMIS) led by National Institutes of Health have been verified to have good reliability, validity and responsiveness, and its results are true and reliable, and have high clinical reference significance. The PROMIS includes short forms, short form collection and computerized adaptive test (CAT), of which the PROMIS CAT is built on scientific item response theory, with the selection of each question highly correlated with the underlying trait of the patient, and the accuracy and credibility of PROs significantly improved. The PROMIS score has been applied in clinical practice in foot and ankle surgery (including hallux valgus, flatfoot and talar neck fractures, etc.) and has demonstrated excellent and stable preoperative prediction and prognosis evaluation ability. The presentation of PROMIS and its application progress can enhance the participation of patients of foot and ankle surgery in medical activities and guide clinical decision-making in foot and ankle surgery.

Evaluation of ankle joint protection effect of parachute ankle brace on paratrooper landing / 中华劳动卫生职业病杂志

Objective: To study the protective effect of parachute ankle brace on ankle joint during simulated parachuting landing. Methods: In August 2021, 30 male paratroopers were selected as the test subjects by simple random sampling method. They jumped from the 1.5 m and 2.0 m height platforms respectively with and without parachute ankle brace, and landed on the sandy ground in a semi-squat parachute landing position. The experiment was divided into 1.5 m experimental group and control group and 2.0 m experimental group and control group. Angle sensor and surface electromyograph were used to measure and analyze the coronal tilt range of the ankle joint and the percentage of maximal voluntary contraction (MVE%) of the muscles around the ankle joint, respectively, to evaluate the protective effect of the parachute ankle brace. Results: At the same height, the tilt range of coronal plane of ankle in experimental group was significantly reduced compared with control group, and the difference was statistically significant (P<0.05). Under the same protection state, the tilt range of the coronal plane of the ankle in the 1.5 m group was significantly reduced compared with that in the 2.0 m group, and the difference was statistically significant (P<0.05). The coronal plane inclination range of the ankle in 2 m experimental group was significantly lower than that in 1.5 m control group, and the difference was statistically significant (P<0.05). Compared with 1.5 m control group, MVE% of right tibialis anterior muscle and bilateral lateral gastrocnemius decreased in 1.5 m experimental group, while MVE% of bilateral peroneus longus increased, with statistical significance (P<0.05). Compared with 2.0 m control group, the MVE% of bilateral tibialis anterior muscle and right lateral gastrocnemius decreased in 2.0 m experimental group, while the MVE% of bilateral peroneus longus increased, with statistical significance (P<0.05). The MVE% of bilateral tibialis anterior muscle, bilateral lateral gastrocnemius muscle and right peroneus longus muscle in 1.5 m experimental group decreased compared with 2.0 m experimental group, and the differences were statistically significant (P<0.05). Compared with 2.0 m control group, the MVE% of bilateral tibialis anterior muscle, right lateral gastrocnemius muscle and right peroneus longus muscle in 1.5 m control group decreased, and the differences were statistically significant (P<0.05) . Conclusion: Wearing parachute ankle brace can effectively limit the coronal plane inclination range of ankle joint, improve the stability of ankle joint and reduce the load on the muscles around ankle joint by landing. Reducing the height of the jumping platform can reduce the coronal plane incline range of the ankle and the muscle load around the ankle during landing.

Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT / 北京大学学报(医学版)

OBJECTIVE@#To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.@*METHODS@#From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.@*RESULTS@#Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.@*CONCLUSION@#Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

Functional training on ankle sprain rehabilitation in soccer players / Treinamento funcional sobre a reabilitação da entorse de tornozelo nos jogadores de futebol / Entrenamiento funcional en la rehabilitación del esguince de tobillo en los jugadores de fútbol

ABSTRACT Introduction An ankle sprain is a common soccer injury. Functional training is used to rehabilitate muscle strength with undiscovered benefits on soccer players' recovery. Objective Explore the functional training effects on ankle injury recovery in soccer players. Methods 29 amateur soccer players were randomly assigned to control (n=15) and experimental (n=14) groups with no statistical difference in age or sex (P>0.05). The experimental group used functional rehabilitation training, while the control group was treated with traditional rehabilitation methods. Both groups practiced 30 to 40 minutes of rehabilitation, three times a week, for two months. Mathematical statistics were used to analyze the effects of different injury rehabilitation on the two groups, estimating the ankle joint continuous motion angle by the tibialis anterior muscle electromyogram responses. Results The ankle instability assessment questionnaires were statistically different between the two groups of patients after rehabilitation training (P<0.05). There was a statistical difference in the agility test after the intervention. The ankle capacity score and agility test score were better in the experimental group (P<0.05). Conclusion Functional rehabilitation training can improve ankle performance after a sprain. This training can also help athletes avoid future sprains and is recommended as preventive training. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução Entorse no tornozelo é uma lesão comum no futebol. O treinamento funcional é utilizado na reabilitação da força muscular com benefícios ainda explorados sobre a recuperação dos jogadores de futebol. Objetivo Explorar os efeitos do treinamento funcional na recuperação das lesões no tornozelo em jogadores de futebol. Métodos 29 jogadores de futebol amador foram aleatoriamente distribuídos em grupo controle (n=15) e experimental (n=14) sem diferença estatística de idade ou sexo (P>0,05). O grupo experimental utilizou treinamento de reabilitação funcional enquanto o grupo controle foi tratado com os métodos tradicionais de reabilitação. Ambos os grupos praticaram 30 a 40 minutos de reabilitação, três vezes por semana, durante dois meses. Estatísticas matemáticas foram utilizadas para analisar os efeitos da reabilitação de lesões diferentes nos dois grupos por estimativa do ângulo de movimento contínuo na articulação do tornozelo com as respostas do eletromiograma do músculo tibial anterior. Resultados Os questionários de avaliação da instabilidade do tornozelo entre os dois grupos de pacientes após o treinamento de reabilitação foram estatisticamente diferentes (P<0,05). Houve diferença estatística no teste de agilidade após a intervenção. A pontuação na capacidade do tornozelo e o escore no teste de agilidade foram melhores no grupo experimental (P<0,05). Conclusão O treinamento de reabilitação funcional pode melhorar o desempenho do tornozelo após a entorse. Este treinamento também pode ajudar os atletas a evitarem futuros entorses, sendo recomendado como treino preventivo. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción El esguince de tobillo es una lesión común en el fútbol. El entrenamiento funcional se utiliza en la rehabilitación de la fuerza muscular con beneficios aún explorados en la recuperación de los jugadores de fútbol. Objetivo Explorar los efectos del entrenamiento funcional en la recuperación de lesiones de tobillo en jugadores de fútbol. Métodos 29 jugadores de fútbol amateur fueron distribuidos aleatoriamente en los grupos de control (n=15) y experimental (n=14) sin diferencias estadísticas en cuanto a edad o sexo (P>0,05). El grupo experimental utilizó un entrenamiento de rehabilitación funcional mientras que el grupo de control fue tratado con métodos de rehabilitación tradicionales. Ambos grupos practicaron entre 30 y 40 minutos de rehabilitación, tres veces por semana, durante dos meses. Se utilizó la estadística matemática para analizar los efectos de las diferentes rehabilitaciones de lesiones en los dos grupos mediante la estimación del ángulo de movimiento continuo en la articulación del tobillo con las respuestas del electromiograma del músculo tibial anterior. Resultados Los cuestionarios de evaluación de la inestabilidad del tobillo entre los dos grupos de pacientes después del entrenamiento de rehabilitación fueron estadísticamente diferentes (P<0,05). Hubo una diferencia estadística en la prueba de agilidad después de la intervención. La puntuación de la capacidad del tobillo y la puntuación de la prueba de agilidad fueron mejores en el grupo experimental (P<0,05). Conclusión El entrenamiento de rehabilitación funcional puede mejorar el rendimiento del tobillo tras un esguince. Este entrenamiento también puede ayudar a los atletas a evitar futuros esguinces y se recomienda como entrenamiento preventivo. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability / Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo

Abstract Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Resumo Objetivo O presente estudo avalia os resultados de uma técnica cirúrgica minimamente invasiva para o manejo da instabilidade aguda e crônica do tornozelo. Métodos O presente estudo de uma série de casos avaliou retrospectivamente 40 pacientes submetidos à reconstrução percutânea assistida por artroscopia do ligamento do tornozelo entre 2013 e 2019. Resultados O estudo incluiu 17 homens e 23 mulheres com idade média de 38,3 anos. O acompanhamento pós-intervenção utilizou a pontuação American Orthopaedic Foot and Ankle Society (AOFAS, na sigla em inglês). As pontuações do tornozelo-retropé identificaram melhora > 30 pontos na função e no controle da dor. As lesões associadas mais frequentes foram as osteocondrais (35%). Nenhum paciente precisou de reintervenção ou teve infecção durante o acompanhamento. Conclusão A técnica do presente estudo é fácil e consegue resultados satisfatórios para a função e o controle da dor. Nível de Evidência IV.

Treatment of Distal Tibiofibular Syndesmosis Injury Associated with Ankle Fractures with Suture Button / Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

Abstract Objective To evaluate the results obtained from the surgical treatment of malleolar ankle fractures associated with distal tibiofibular syndesmosis (DTFS) injury submitted to conventional surgical procedure for fracture fixation and DTFS fixation by suture button (SB). Methods Forty-nine patients were retrospectively evaluated, with a mean age of 45 years old and a mean follow-up of 34.1 months. Clinical and functional evaluation was based on the visual analogue scale (VAS) and on the American Foot and Ankle Society Score (AOFAS) for ankle and hindfoot, return to routine activities, and return to sport. Results The postoperative mean AOFAS and VAS were, respectively, 97.06 (confidence interval [CI 95%: 95.31-98.81] and 0.16 [CI 95% 0,04 - 0,29]. All patients returned to previous daily activities, and only 12 showed some residual symptom. There was no postoperative instability in any patient. Forty-six patients returned to sports activities and, of these, only 1 did not return to the level prior to the injury. Only two patients presented SB-related alterations. There was no report of dissatisfaction. Conclusion In malleolar fractures of the ankle with DTFS injury, the fixation of syndesmosis with SB demonstrated excellent postoperative results. Level of Evidence IV, retrospective case series.

Resumo Objetivo Avaliar os resultados obtidos do tratamento cirúrgico das fraturas maleolares do tornozelo associadas a lesão da sindesmose tibiofibular distal (STFD) submetidas a procedimento cirúrgico convencional de fixação da fratura e fixação da STFD pelo suture button (SB). Métodos Avaliou-se retrospectivamente 49 pacientes com uma média de idade de 45 anos e seguimento médio de 34,1 meses. A avaliação clínica e funcional foi baseada na escala visual analógica (EVA) e na escala American Foot and Ankle Society Score (AOFAS, na sigla em inglês) para tornozelo e retropé, retorno às atividades da rotina e retorno ao esporte. Resultados As médias pós-operatórias das escalas AOFAS e EVA foram, respectivamente, 97,06 (índice de confiança [IC 95%: 95,31 - 98,81] e 0,16 [IC 95% 0,04 - 0,29]. Todos os pacientes retornaram às atividades prévias do cotidiano, sendo que apenas 12 apresentaram algum sintoma residual. Não se verificou instabilidade pós-operatória em nenhum paciente. Ao todo, 46 pacientes retornaram às atividades desportivas e, destes, apenas 1 não retornou ao nível prévio à lesão. Apenas dois pacientes apresentaram alterações relacionadas ao SB. Não houve relato de insatisfação. Conclusão Em fraturas maleolares do tornozelo com lesão da STFD, a fixação da sindesmose com o SB demonstrou excelentes resultados pós-operatórios. Nível de Evidência IV, série de casos retrospectiva.