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Prospective Evaluation of Syndesmotic Ankle Sprains Without Diastasis

Eric D. Nussbaum, MEd, ATC, Timothy M. Hosea, MD^,, Shawn D. Sieler, MD, Brian R. Incremona, MD and Donald E. Kessler, MEd, ATC

Division of Athletics, Rutgers University, Piscataway, New Jersey
Division of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey

Presented at the 22nd annual meeting of the AOSSM, Lake Buena Vista, Florida, June 1996.

Address correspondence and reprint requests to Timothy M. Hosea, MD, 215 Easton Avenue, New Brunswick, NJ 08901

Sixty consecutive collegiate athletes with "high" ankle symptoms were prospectively evaluated over a 3-year period in an effort to better define this debilitating ankle injury. All athletes included in this study had tenderness over the distal anterior tibiofibular ligament, tenderness proximally along the interosseous membrane, and functional disability. No study subject had a fracture or frank tibia-fibula diastasis. The severity of the sprain was quantified using the interosseous "tenderness length." A standard rehabilitation protocol was followed by all patients. Athletes returned to competition when they could perform all functional testing without difficulty. Time to return to full competitive activity averaged 13.4 days. The number of days missed from competition was statistically related to the interosseous tenderness length (P = 0.0001) and to positive results on the squeeze test (P = 0.03). Fifty-three of the 60 injured athletes were evaluated at least 6 months after injury. Patients rated their outcomes as good or excellent. Six of the patients experienced occasional ankle pain and stiffness, four patients reported recurrent ankle sprains, and one patient had heterotopic ossification formation.

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