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Syndesmosis Ligament Rupture


There is a severe sharp pain around the anterior tibio fibula junction, haemarthrosis and sense of ankle instability after a severe hyperflexion – inversion or eversion ankle sprain. A player cannot continue and will limp off the pitch. This injury is well-known in association with a fracture but occurs frequently in isolation in contact sports such as football and rugby.


There is an anterior, mid and posterior portion of the syndesmosis ligament, the midportion being the interosseous membrane. All these structures can be damaged individually or in combin ation. Even though these injuries are fairly rare they must not be missed.


There is tenderness on palpation over the anterior syndesmosis ligament and bruising/swelling-haemarthrosis. There is an increased laxity which is sometimes mistaken for positive anterior drawer and talar tilt tests. Perform a forced dorsi-flexion and eversion while palpating the anterior syndesmosis. Pain indicates a positive syndesmosis test and a tear of the ligament. If there is a complete tear of the three structures, the fibula can be translated both anteriorly and posteriorly without resistance holding fibula between the thumb and index finger.


X-ray is often normal unless taken in the weight-bearing position when there is a complete rupture of all three  components. MRI may show localised oedema and effusion over the syndesmosis ligament but as a static examination it cannot fully show the extent of the instability that this injury causes. Clinical findings are most import.


In the acute phase RICE and nonweight bearing is advocated until the full extent of the injury is defined. A non-weight-bearing boot or crutches with non-weight-bearing should be used. In partial ruptures, proprioceptive training and partial weight-bearing exercises are often allowed after four to six weeks. Rehabilitation is usually curative

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