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Return-to-Sport Outcomes After Suture Button Fixation for Syndesmotic Injury in Elite Athletes With Chronic Lateral Ankle Instability: A Prospective Case Series

Orthopaedic journal of sports medicine · 2026

98.5% of elite athletes returned to sport in ~8 weeks after combined ankle ligament and syndesmotic surgery, but with no control group we can't credit the added hardware.

sports-medicineathletic-trainingfoot-anklereturn-to-sportimaging-diagnosticscohort-observational

Studiet

Prospective case series, Level IV evidence, n=68 elite athletes (70 enrolled) with chronic lateral ankle instability and confirmed syndesmotic injury undergoing combined arthroscopic modified Broström procedure (AMBP) plus suture button fixation (SBF), minimum 2-year follow-up.

Hvad de fandt

98.5% (67/68) returned to sport at a mean 53.2 ± 14.7 days, with significant improvements on all FAOS subscales and the Karlsson-Peterson score (P < .001) and only one minor complication (transient wound irritation, 1.5%). Greater BMI reduction (β = 1.8, 95% CI 1.1-3.1, P = .032) and smaller preoperative syndesmotic area (β = -0.7, 95% CI 0.5-0.9, P = .018) independently predicted greater FAOS improvement.

Vurderingen

This is a single-arm case series with no comparison group (e.g., AMBP alone, or a non-operative/historical cohort), so the pre-post PRO improvements — while statistically significant — are unsurprising for surgical patients starting from a symptomatic baseline and cannot be attributed specifically to adding SBF. There's no blinding of outcome assessment, the population is a highly selected elite-athlete cohort with confirmed syndesmotic pathology (limiting generalizability), and the 'significant predictor' findings from multivariate regression in a sample of 68 risk being overfit given the number of candidate variables tested.

Begrænsningen

Without a comparator arm (AMBP alone, or SBF only) you cannot tell whether the syndesmotic fixation added meaningful benefit over the gold-standard Broström procedure by itself, or whether these RTS outcomes simply reflect a well-selected elite population with excellent access to rehab.

Referencestudie

This sits downstream of the established literature establishing AMBP as the gold-standard surgical treatment for chronic lateral ankle instability; it extends that base into the less-studied niche of concomitant syndesmotic instability, an area with a much smaller and mostly case-series-level evidence pool rather than a single defining landmark trial.

Hvad du gør på mandag

No change for routine CLAI management — this doesn't alter first-line surgical decision-making for typical isolated lateral ankle instability. For surgeons already treating elite athletes with confirmed concomitant syndesmotic injury via combined AMBP+SBF, it offers reassurance on RTS timelines and complication rates, and a rationale for emphasizing postoperative weight management as an adjunct to rehab.

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