BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report exp...BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.展开更多
Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequatel...Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.展开更多
INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is requi...INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is required for weight transmission and walking. The syndesmosis consists of the anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous membrane. Internal fixations of the syndesmosis were recommended by most authors to repair the associated ruptured ligaments, which bring about the adverse consequences of limiting the physiological micromovement of the tibiofibular joint to some extent.展开更多
Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndes...Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis. Methods： From July 1997 to July 2002, we treated 87 patients （64 males and 23 females, aged 18-54 years） with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus Iongus, reduction of the separated distal tibiofibuiar syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30° when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation. Results： These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint： excellent in 55 patients （63 % ）, good in 18 patients （ 21% ）, and fair in 14 patients （16%）. Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus Iongus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise. Conclusions ： Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus Iongus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.展开更多
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may aris...Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>展开更多
The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes...The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes the available evidence in the light of the author’s opinion.Pre-operative radiographic assessment,standard radiographs,computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning.Intra-operative stress testing,in the sagittal,coronal or exorotation direction,is more reliable in the diagnosis of syndesmotic instability of rotational ankle fractures.The Hook or Cotton test is more reliable than the exorotation stress test.The lateral view is more reliable than the AP mortise view because of the larger displacement in this direction.When the Hook test is used the force should be applied in the sagittal direction.A force of 100 N applied to the fibula seems to be appropriate.In the case of an unstable joint requiring syndesmotic stabilisation,the tibiofibular clear space would exceed 5 mm on the lateral stress test.When the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the syndesmosis.Many guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established.展开更多
A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently acco...A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle fracture.The diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this day.Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes.In such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can result.This paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.展开更多
BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupt...BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.展开更多
Ankle injuries are commonplace in the athletic population, with lateral ligamentsprains accounting for the majority of them. The medial ligament complex, thedistal tibiofibular syndesmosis as well as any of the bones ...Ankle injuries are commonplace in the athletic population, with lateral ligamentsprains accounting for the majority of them. The medial ligament complex, thedistal tibiofibular syndesmosis as well as any of the bones that constitute the anklejoint can also be injured. Typical mechanisms of injury include inversion-plantarflexionand external rotation on a supinated, dorsiflexed or pronated foot. Lesionsof the ankle present with similar symptoms of pain, swelling and tenderness.Therefore, a thorough history and physical examination must be obtained to makethe correct diagnosis. This is especially critical for athletes as certain injuries canlead to termination of their career if not treated accurately on time. Imaging maybe useful in some cases to confirm or rule out differential diagnoses. Most injuriescan be managed conservatively using the Protection, Rest, Ice, Compression andElevation protocol followed by a comprehensive rehabilitation programme.Surgery is reserved for grade III ligament tears that are refractory to initial nonoperativetreatment and displaced fractures that are unlikely to unite withoutsurgical intervention. The objective of this review is to discuss the common ankleinjuries encountered in the athletic population and the approaches to theirdiagnosis and management.展开更多
Reconstruction of unstable syndesmotic injuries is not trivial,and there is no generally accepted treatment guidelines.Thus,there still remain considerable controversies regarding diagnosis,classification and treatmen...Reconstruction of unstable syndesmotic injuries is not trivial,and there is no generally accepted treatment guidelines.Thus,there still remain considerable controversies regarding diagnosis,classification and treatment of syndesmotic injuries.Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery,and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%.Outcome of ankle fractures with syndesmosis injury is worse than without,even after surgical syndesmotic stabilization.This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls.Therefore,even open visualization of the syndesmosis during the reduction maneuver has been recommended.Thus,the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis.In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws.However,rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?.Therefore,we developed a new syndesmotic Internal Brace^(TM)technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments.The Internal Brace^(TM)technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~?for knotless aperture fixation of a Fiber Tape~?at the anatomic footprints of the augmented ligaments,and augmentation of the anterior talofibular ligament,the deltoid ligament,the spring ligament and the medial collateral ligaments of the knee have been published so far.According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM)technique alone as a single anterior stabilization,or in combination with one posteriorly directed Tight Rope~?as a double stabilization,or in combination with one Tight Rope~?and a posterolateral malleolar screw fixation as a triple stabilization.Moreover,the syndesmotic Internal Brace^(TM)technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an Internal Brace^(TM)after osteosynthesis of the distal fibula.In this paper,comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic Internal Brace^(TM)technique.A clinical trial for evaluation of the functional outcomes has been started at our hospital.展开更多
文摘BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.
文摘Disruption of the distal tibiofibular syndesmosis is frequently accompanied by rotational ankle fracture such as pronation-external rotation and rarely occurs without ankle fracture.In such injury,not only inadequately treated or misdiagnosed cases,but also correctly diagnosed cases can possibly result in a chronic pattern which is more troublesome to treat than an acute pattern.This paper reviews anatomical and biomechanical characteristics of the distal tibiofibular joint,the mechanism of chronic disruption of the distal tibiofibular syndesmosis,radiological and arthroscopic diagnosis,and surgical treatment.
文摘INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is required for weight transmission and walking. The syndesmosis consists of the anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous membrane. Internal fixations of the syndesmosis were recommended by most authors to repair the associated ruptured ligaments, which bring about the adverse consequences of limiting the physiological micromovement of the tibiofibular joint to some extent.
文摘Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis. Methods： From July 1997 to July 2002, we treated 87 patients （64 males and 23 females, aged 18-54 years） with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus Iongus, reduction of the separated distal tibiofibuiar syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30° when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation. Results： These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint： excellent in 55 patients （63 % ）, good in 18 patients （ 21% ）, and fair in 14 patients （16%）. Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus Iongus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise. Conclusions ： Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus Iongus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.
文摘Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>
文摘The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes the available evidence in the light of the author’s opinion.Pre-operative radiographic assessment,standard radiographs,computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning.Intra-operative stress testing,in the sagittal,coronal or exorotation direction,is more reliable in the diagnosis of syndesmotic instability of rotational ankle fractures.The Hook or Cotton test is more reliable than the exorotation stress test.The lateral view is more reliable than the AP mortise view because of the larger displacement in this direction.When the Hook test is used the force should be applied in the sagittal direction.A force of 100 N applied to the fibula seems to be appropriate.In the case of an unstable joint requiring syndesmotic stabilisation,the tibiofibular clear space would exceed 5 mm on the lateral stress test.When the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the syndesmosis.Many guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established.
文摘A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle fracture.The diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this day.Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes.In such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can result.This paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.
文摘BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.
文摘Ankle injuries are commonplace in the athletic population, with lateral ligamentsprains accounting for the majority of them. The medial ligament complex, thedistal tibiofibular syndesmosis as well as any of the bones that constitute the anklejoint can also be injured. Typical mechanisms of injury include inversion-plantarflexionand external rotation on a supinated, dorsiflexed or pronated foot. Lesionsof the ankle present with similar symptoms of pain, swelling and tenderness.Therefore, a thorough history and physical examination must be obtained to makethe correct diagnosis. This is especially critical for athletes as certain injuries canlead to termination of their career if not treated accurately on time. Imaging maybe useful in some cases to confirm or rule out differential diagnoses. Most injuriescan be managed conservatively using the Protection, Rest, Ice, Compression andElevation protocol followed by a comprehensive rehabilitation programme.Surgery is reserved for grade III ligament tears that are refractory to initial nonoperativetreatment and displaced fractures that are unlikely to unite withoutsurgical intervention. The objective of this review is to discuss the common ankleinjuries encountered in the athletic population and the approaches to theirdiagnosis and management.
文摘Reconstruction of unstable syndesmotic injuries is not trivial,and there is no generally accepted treatment guidelines.Thus,there still remain considerable controversies regarding diagnosis,classification and treatment of syndesmotic injuries.Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery,and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%.Outcome of ankle fractures with syndesmosis injury is worse than without,even after surgical syndesmotic stabilization.This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls.Therefore,even open visualization of the syndesmosis during the reduction maneuver has been recommended.Thus,the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis.In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws.However,rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?.Therefore,we developed a new syndesmotic Internal Brace^(TM)technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments.The Internal Brace^(TM)technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~?for knotless aperture fixation of a Fiber Tape~?at the anatomic footprints of the augmented ligaments,and augmentation of the anterior talofibular ligament,the deltoid ligament,the spring ligament and the medial collateral ligaments of the knee have been published so far.According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM)technique alone as a single anterior stabilization,or in combination with one posteriorly directed Tight Rope~?as a double stabilization,or in combination with one Tight Rope~?and a posterolateral malleolar screw fixation as a triple stabilization.Moreover,the syndesmotic Internal Brace^(TM)technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an Internal Brace^(TM)after osteosynthesis of the distal fibula.In this paper,comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic Internal Brace^(TM)technique.A clinical trial for evaluation of the functional outcomes has been started at our hospital.
