The role of anatomical repair of the anterior inferior tibiofibular ligament in acute ankle fractures with syndesmotic injury: A systematic review

Abstract

The management of syndesmotic injury in ankle fractures is still controversial. Anterior inferior tibiofibular ligament (AITFL) primary repair is considered essential to reduce the risk of syndesmotic malreduction. This review examined the available literature on primary AITFL repair in ankle fractures. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Cochrane, and Google Scholar were searched up to July 15, 2021, for articles reporting on the repair of AITFL in acute ankle fractures with syndesmotic injury. The quality of the included studies was assessed using the Newcastle-Ottawa scale. Studies that investigated isolated syndesmotic injury without ankle fracture, reviews, cadaveric studies, case reports, and studies not published in English were excluded from the study. The search yielded 588 articles, of which three studies were included, with a total of 229 AITFL primary repairs. The articles were excluded due to different design, foreign language, irrelevancy, or no syndesmosis injury, including patients with isolated syndesmosis injury or used methods of repair other than anatomical repair. Early functional outcomes were found better after AITFL repair compared to syndesmotic screw fixation alone. Moreover, time to return to play/work was significantly lower in the anatomical repair compared to temporary screw fixation. Anatomical repair of the ankle syndesmosis is an effective and safe method with good functional outcomes and return to activity. However, the future prospective studies are required to assess the efficacy of the anatomical repair of the syndesmosis and its superiority over other treatments.