Abstract
PurposeRecently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the biomechanical properties, functional outcome, need for implant removal, and the complication rate of syndesmotic disruptions treated with a suture-button device with the current 'gold standard', i.e. the syndesmotic screw.MethodA literature search in the electronic databases of the Cochrane Library, EMbase, Pubmed Medline, and Google Scholar, between January 1st 2000 to December 1st 2011, was conducted to identify studies in which unstable ankle fractures with concomitant distal tibiofibular syndesmotic injury were treated with either a syndesmotic screw or a suture-button device.ResultsA total of six biomechanical studies, seven clinical full-text studies and four abstracts on the TightRope system, and 27 studies on syndesmotic screw or bolt fixation were identified. The AOFAS of 133 patients treated with TightRope was 89.1 points, with an average study follow-up of 19 months. The AOFAS score in studies with 253 patients treated with syndesmotic screws (metallic and absorbable) or bolts was 86.3 points, with an average study follow-up of 42 months. Two studies reported an earlier return to work in the TightRope group. Implant removal was reported in 22 (10%) of 220 patients treated with a TightRope (range, 0–25%), in the screw or bolt group the average was 51.9% of 866 patients (range, 5.8–100%).ConclusionThe TightRope system has a similar outcome compared with the syndesmotic screw or bolt fixation, but might lead to a quicker return to work. The rate of implant removal is lower than in the syndesmotic screw group. There is currently insufficient evidence on the long-term effects of the TightRope and more uniform outcome reporting is desirable. In addition, there is a need for studies on cost-effectiveness of the treatment of acute distal tibiofibular syndesmotic disruption treated with a suture-button device.
Highlights
IntroductionIt is estimated that 10% of all ankle fractures and 20% of operatively treated ankle fractures are accompanied by a syndesmotic injury [12, 16, 49, 54, 62]
The TightRope system has a similar outcome compared with the syndesmotic screw or bolt fixation, but might lead to a quicker return to work
There is a need for studies on cost-effectiveness of the treatment of acute distal tibiofibular syndesmotic disruption treated with a suture-button device
Summary
It is estimated that 10% of all ankle fractures and 20% of operatively treated ankle fractures are accompanied by a syndesmotic injury [12, 16, 49, 54, 62]. Because of the contradicting goals in treatment, i.e. rigid fixation for an adequate period on one hand versus early return to full range of motion at the syndesmosis on the other, various different strategies have been used throughout the years. Among these are the metallic syndesmotic screw, which is currently considered the 'gold standard', bioabsorbable screws, bolt-fixation, syndesmotic hook, integrated syndesmotic fixation with nail (ANK), staples, direct repair, and the use of suture-loops with or without endobuttons [15, 26, 36, 40, 47, 56]. This system is compiled of two No5 braided polyester sutures and two titanium or stainless steel endobuttons
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