Prognosis of Ankle Syndesmosis Injury

Ankle syndesmosis injury has been linked with persistent pain and prolonged recovery; however no predictors of prolonged recovery have been identified. The authors’ objectives in this study were to establish prognosis for ankle syndesmosis injury compared to a lateral ankle sprain, and examine factors connected with prolonged recovery. Participants (n=63) aged 21±3.2years, with acute ankle ligament injuries (MRI diagnosed) were recruited from ten sport clubs, and sports medicine and physiotherapy clinics in two Australian cities. Follow-up was until full recovery and with pre-injury activity level. Time to return to play was compared between injury types using Kaplan-Meier survival curves. Secondary analysis investigated putative factors that increased risk of prolonged recovery. For this analysis, participants unrecovered at two weeks completed: the Fear Avoidance Beliefs Questionnaire (FABQ); Star Excursion Balance Test (SEBT), weight bearing lunge, and vertical jump (VJ). These variables were correlated with time to recovery using bivariate Pearson’s r correlation coefficient. Median recovery time for conservatively treated ankle syndesmosis injury was 62 days and 15 days for lateral sprain. Sport specific subscale scores of the FABQ were significantly higher (p=0.017) for the ankle syndesmosis group whereas vertical jump height was lower for this group, (p=0.052). No baseline variables were strong predictors (r=≥0.6) of recovery. Moderate correlations were found for VJ (r=-.471, p=0.004) and the sport specific subscale of the FABQ (r=.463, p=0.004).

Their study found that conservatively treated ankle syndesmosis injuries took four times longer to recover than lateral ankle sprain. They concluded that tests like as VJ and FABQ may identify individuals at risk of prolonged recovery and enable health professionals to determine realistic and appropriate time to recovery.