Clinical Manifestations, Diagnosis and Management of Synovial Fistula Associated Lateral Ankle Sprain or Instability: A Retrospective Study of 19 Surgically Confirmed Patients.

Jahyung Kim,Jae-Shin Yang,Altanzul Bat-Ulzii,Bum-Jin Shim,Jaeho Cho

doi:10.3390/ijerph19042428

Abstract

We aimed to investigate the preoperative history, clinical manifestations, imaging findings, and postoperative clinical outcomes for patients with surgically confirmed synovial fistula around the ankle joint. 19 consecutive patients who were confirmed to have synovial fistula in the surgical field were enrolled in this study. Medical records of all patients in terms of preoperative details, operative findings, and postoperative outcomes at 1 year after the surgery were retrieved. As a diagnostic modality, the normal saline test or MRI was used. Intraoperatively, the synovial fistula was repaired with the capsuloligamentous repair or additional periosteal augmentation. All patients had a history of ankle sprain prior to symptoms and showed positive results in the saline load test. One patient had recurred symptom after the surgery, so needed a revisional periosteal augmentation. At 1 year follow-up period, the average Foot ankle outcome score was 87.65 and no surgery-related complication was detected. Synovial fistula of the ankle joint needs to be taken into consideration as a possible complication in patients with ankle sprain history and recurrent joint swelling. The saline load test would be useful for its diagnosis, and treatment should be focused on the complete closure of capsular opening along with restoration of its surrounding pathologic conditions.

Highlights

Synovial fistula (SF) of joint is a rare pathologic condition that is formed through a defect within the joint capsule
Nineteen consecutive patients with recurrent ankle swelling around the lateral ankle, who were confirmed to have SF in the surgical field between 2016 January and 2020 December were enrolled in this study
The ankle was manipulated through its range of motion and a soft tissue dilation around the lateral malleolar area was observed for extravasation of fluid

Summary

Introduction

Synovial fistula (SF) of joint is a rare pathologic condition that is formed through a defect within the joint capsule. There have been several reports of SF around the knee, shoulder, and wrist joints, which developed in the wake of intra-articular surgeries such as arthroscopic procedures [1,2,3,4,5,6,7]. If an excessive amount of synovial fluid is drained externally, SF can be communicated to an adjacent bursal sac [8,9,10]. The SF is generally presumed to be iatrogenic and can accompany a communication with adjacent extracapsular spaces including bursal sac. Not many cases of SF of the ankle joint have been reported, most of these were found in association with adjacent bursitis [11,12,13]

Objectives

Methods

Results

Discussion

Conclusion