Stable versus Unstable Grade 2 High Ankle Sprains in Athletes: A Noninvasive Tool to Predict the Need for Surgical Fixation

There are no standardized criteria for the diagnosis and management of syndesmotic injuries, creating great ambiguity regarding optimal treatment. Traditionally, individuals with clinical and/or radiological suspicion of syndesmotic instability warrant an examination under anaesthesia and/or diagnostic arthroscopy to confirm and treat. Our purpose was to identify clinical syndesmotic instability without the need of invasive arthroscopic procedures. However, the invasive process of this has inherent risks to the patient. We developed a device to dynamically evaluate the distal tibiofibular stability during external rotation of the ankle as an extension to the available clinical tests. We compared the results of this device with intra-operative arthroscopic findings in 15 athlete cases with isolated grade 2 syndesmotic instability and found very good correlation, especially when tested in dorsiflexion. We consider this syndhoo device very helpful as part of the available options in the clinical diagnosis of syndesmotic instability.