Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years

Authors

  • Benedikte Wendt Ræder Department of Orthopaedic Surgery, Baerum Hospital, Vestre Viken Hospital Trust
  • Ingrid Kvello Stake Kalnes Hospital, Østfold Hospital Trust
  • Jan Erik Madsen Division of Orthopaedic Surgery, Oslo University Hospital; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
  • Frede Frihagen Division of Orthopaedic Surgery, Oslo University Hospital
  • Silje Berild Jacobsen Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo
  • Mette Renate Andersen Department of Orthopaedic Surgery, Baerum Hospital, Vestre Viken Hospital Trust; Aleris Hospital, Tromsø, Norway
  • Wender Figved Department of Orthopaedic Surgery, Baerum Hospital, Vestre Viken Hospital Trust

DOI:

https://doi.org/10.1080/17453674.2020.1818175

Abstract

Background and purpose — Better outcomes are reported for suture button (SB) compared with syndesmotic screws (SS) in patients treated for an acute ankle syndes- motic injury. One reason could be that screws are more rigid than an SB. A single tricortical 3.5 mm syndesmotic screw (TS) is the most dynamic screw option. Our hypothesis is that 1 SB and 1 TS provide similar results. Therefore, in ran- domized controlled trial, we compared the results between SB and TS for syndesmotic stabilization in patients with acute syndesmosis injury.

Patients and methods — 113 patients with acute syn- desmotic injury were randomized to SB (n = 55) or TS (n = 58). The American Orthopedic Foot & Ankle Society (AOFAS) Ankle–Hindfoot Score was the primary outcome measure. Secondary outcome measures included Manches- ter Oxford Foot Questionnaire (MOXFQ), Olerud–Molan- der Ankle score (OMA), visual analogue scale (VAS), EuroQol- 5D (EQ-5D), radiologic results, range of motion, complications, and reoperations (no implants were routinely removed). CT scans of both ankles were obtained after sur- gery, and after 1 and 2 years.

Results — The 2-year follow-up rate was 84%. At 2 years, median AOFAS score was 97 in both groups (IQR SB 87–100, IQR TS 90–100, p = 0.7), median MOXFQ index was 5 in the SB group and 3 in the TS group (IQR 0–18 vs. 0–8, p = 0.2), and median OMA score was 90 in the SB group and 100 in the TS group (IQR 75–100 vs. 83–100, p = 0.2). The syndesmotic reduction was similar 2 years after surgery; 19/55 patients in the SB group and 13/58 in the TS group had a difference in anterior syndesmotic width ≥ 2 mm (p = 0.3). 0 patients in the SB group and 5 patients in the TS group had complete tibiofibular synostosis (p = 0.03). At 2 years, 10 TS were broken. Complications and reoperations were similar between the groups.

Interpretation — We found no clinically relevant differ- ences regarding outcome scores between the groups. TS is an inexpensive alternative to SB.

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Published

2020-09-10

How to Cite

Ræder, B. W., Stake, I. K. ., Madsen, J. E. ., Frihagen , F. ., Jacobsen, S. B. ., Andersen, M. R. ., & Figved, W. . (2020). Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years. Acta Orthopaedica, 91(6), 770–775. https://doi.org/10.1080/17453674.2020.1818175