Evaluation and management of ankle syndesmosis injuries

Background: Ankle injuries are common in sporting activities with damage to the inferior tibiofibular ligaments being notable for their resultant disability and prolonged recovery. Objective: To provide a synopsis of the current best evidence regarding the recognition and treatment of injury to the syndesmotic ligaments of the ankle. Design: Structured narrative overview. Methods: Keyword search of Medline, CINAHL, and PEDro databases for studies published in English from January 1985 to July 2010. In addition, the reference lists from articles obtained were manually searched for relevant literature. Summary: This manuscript provides an overview of the distal tibiofibular pathologies, discusses the accuracy, limitations, and prognostic ability of clinical and radiographic examination techniques, and presents a philosophical approach to the rehabilitative management of syndesmotic injuries that integrates known biomechanical influences. Conclusion: An appreciation for the mechanism of injury and a careful examination can distinguish these injuries from other forms of ankle instability. Proper recognition and immediate attention to the unique complexities of this joint can minimize morbidity and prevent a delayed return to sports.