Augmented Anterior Inferior Tibiofibular Ligament Repair and its Short-Term Postoperative Effects on 3D Syndesmotic Volumes: A Randomized Clinical Pilot Study.

Abstract

Dynamic fixation using the TightRope® system has led to improvements in outcomes after complex ankle syndesmotic injuries. Augmenting tightrope fixation with a repair of the anterior inferior tibiofibular ligament has been proposed to reconstruct the syndesmosis more accurately. Clinical studies using this technique are limited. To determine if surgical technique influenced immediate postoperative reduction of the syndesmosis and immediate and short-term patient-reported outcomes. We also explored relationships between postoperative volumes and patient-reported outcomes. Randomized clinical pilot study METHODS: Twenty patients with syndesmotic injuries were blinded and randomly assigned into tightrope (n=11; 50.5±13.3yrs) or tightrope with augmentation (n=9; 55.9±19.3yrs) groups. Our primary outcome, postoperative reduction, was assessed by 3D volumetric ratios measured by weightbearing computed tomography at 6-weeks and 3-months post-operation. Our secondary outcomes, Foot and Ankle Outcome Score and the RAND-36, were collected preoperatively, and at 6-weeks, 3-months, 6-months, and 1-year post-operation. Differences in volumetric ratios and outcomes were evaluated between groups and time periods. No significant differences were found in syndesmotic volumetric ratios between groups at either time point. An increase was observed in postoperative volumes in those with Weber C fractures between 6-weeks and 3-months. Both groups reported improved outcomes after fixation, but surgical technique did not influence them. Additionally, we did not find any relationship between volumetric ratios and outcomes. Both techniques produced similar immediate- and short-term clinical outcomes. Future studies with larger samples and those looking at the potential influence of these techniques in various fracture classifications are warranted. Level II, therapeutic, pilot randomized controlled trial.