Simultaneous Single-Graft Tibiofibular Syndesmosis and Deltoid Ligament Reconstruction in Chronic Instability: Technical Tip.

Syndesmosis injury has been reported in up to 18% of sprains and 23% of ankle fractures.8 Failing to diagnose its involvement leads to neglected and malreduced ankle syndesmosis, resulting in pain, impairment, and poor clinical outcomes.5 The orthopaedic surgeon confronts a challenge when managing chronic injuries (>6 months) as standard repair techniques are no longer ideal. Recent studies have shown that restoring syndesmosis congruency and stability leads to improved outcomes and reduced posttraumatic arthritis.5 Among the available surgical options for chronic injuries, tibiofibular stabilization and arthrodesis yield improved American Orthopaedic Foot & Ankle Society (AOFAS) scores.5,8 Arthrodesis has been recommended for lesions with significant displacement, but the subsequently limited range of motion narrows its indication to nonactive patients.5 In contrast, anteroinferior tibiofibular (AITFL) and interosseous ligament (IOL) reconstruction techniques with autografts can yield better functional results by preserving its physiologic joint micromotion.8 The evidence on reconstruction techniques with tendon grafts is limited to case series, and no technique has been deemed superior5—even more so when associated with deltoid ligament (DL) injuries, as this injury pattern represents a critical syndesmosis instability. The aim of this study is to describe a modified Morris et al7 surgical technique to simultaneously reconstruct the tibiofibular syndesmosis and DL with a single autograft.