Ankle Syndesmosis Injury

Ankle syndesmosis injuries, commonly referred to as “high ankle sprains,” are a complex and often misunderstood injury that affect the distal tibiofibular joint.

These injuries are frequently seen in athletes, particularly in contact sports like football, rugby, and skiing, but can also occur in the general population due to twisting or high-energy trauma.

At Perth Orthopaedic & Sports Medicine Centre, Dr Daniel Meyerkort offers expert diagnosis and treatment of syndesmosis injuries. A key part of the treatment pathway includes assessing injury severity and tailoring management options – ranging from non-operative rehabilitation to advanced surgical techniques like the Arthrex Double TightRope fixation.

What Is a Syndesmosis Injury?

The syndesmosis is a fibrous joint where the tibia and fibula are joined by strong ligaments. It plays a crucial role in ankle stability, particularly during weight-bearing and dynamic movements. Injuries to this structure typically occur due to external rotation forces, dorsiflexion injuries, or direct trauma to the lateral ankle or leg.

Symptoms include:

  • Pain above the ankle joint

  • Difficulty weight-bearing

  • Instability with walking

  • Swelling and tenderness over the syndesmosis

Diagnosis is confirmed through physical examination, weight-bearing radiographs, and often an MRI or CT scan for surgical planning.

Non-Surgical Management of Ankle Syndesmosis Injuries

Mild syndesmosis injuries (Grade I and some Grade II) can often be treated conservatively. Non-surgical management typically involves:

1. Immobilisation:

  • A CAM boot or cast may be used for 2–4 weeks to allow healing.

  • Crutches to offload weight initially, followed by a gradual return to full weight-bearing.

2. Physiotherapy:

  • Progressive rehabilitation focusing on range of motion, proprioception, strength, and balance.

  • Close monitoring for signs of instability or delayed healing.

3. Return to Activity:

  • Typically 6–8 weeks for mild injuries.

  • Clearance is based on functional assessments and imaging confirmation of ligament integrity.

Dr Daniel Meyerkort works closely with physiotherapists in Perth and regional WA to provide structured rehabilitation protocols. For athletes, we implement accelerated rehabilitation programs where clinically appropriate, with emphasis on early mobilisation, neuromuscular retraining, and sport-specific drills.

Surgical Management of Syndesmosis Injuries

Surgical treatment is required for unstable syndesmosis injuries (Grade II/III), particularly those associated with fractures, diastasis (widening), or failure of conservative treatment. The goal of surgery is to restore anatomical alignment and allow ligament healing under stable conditions.

The Arthrex Double TightRope Technique

One of the most effective and modern approaches to syndesmotic fixation is the Arthrex Double TightRope® system. This minimally invasive surgical technique provides strong, dynamic fixation of the syndesmosis without the need for traditional metal screws.

Procedure Overview:

  • Two high-strength sutures are passed between the tibia and fibula using specialised drill guides.

  • The sutures are tensioned and secured with metallic or bio-composite buttons.

  • This flexible fixation allows natural physiological micromotion, aiding in more anatomical healing.

Benefits of the Arthrex Double TightRope Technique

The TightRope system has revolutionised the treatment of high ankle sprains and syndesmosis injuries. Some of its key advantages include:

✓ Minimally Invasive

  • Small incisions and reduced soft tissue trauma

  • Lower risk of wound complications

✓ Physiological Stabilisation

  • Allows controlled motion between tibia and fibula during healing

  • Reduces the chance of over-constraining the joint

✓ No Need for Screw Removal

  • Unlike metal screw fixation, which often requires a second surgery to remove hardware, the TightRope system avoids this step in most cases.

✓ Accelerated Rehabilitation

  • Patients can begin weight-bearing earlier compared to screw fixation

  • Earlier return to sport and work activities

  • Particularly beneficial for elite athletes and active individuals

✓ Lower Risk of Hardware Failure

  • Screws can break or loosen; TightRope construct provides more durable fixation with fewer mechanical issues

 

Risks & Considerations

As with any surgical procedure, there are potential risks. These include:

  • Infection

  • Nerve irritation (superficial peroneal nerve)

  • Button prominence or irritation

  • Incomplete reduction or malreduction if not properly executed

  • Potential need for revision surgery in complex cases

However, in experienced hands such as Dr Meyerkort’s, complications are rare and outcomes are excellent when the technique is combined with precise imaging and post-operative protocols.

Accelerated Rehabilitation After TightRope Surgery

One of the standout benefits of the TightRope system is the ability to initiate an accelerated rehab protocol. Post-operative management at Perth Orthopaedic & Sports Medicine Centre typically includes:

Week 0–2:

  • Weight-bearing in a CAM boot as tolerated

  • Ankle range of motion exercises commence early

  • Pain and swelling control strategies (ice, elevation, compression)

Week 3–6:

  • Transition from boot to supportive shoe

  • Progressive strengthening, balance, and proprioceptive exercises

  • Low-impact cardio (e.g., cycling, swimming)

Week 6–12:

  • Sport-specific drills and agility training

  • Return to jogging and non-contact sports

Week 12+:

  • Full return to competitive sports following clearance from Dr Meyerkort and your physiotherapist

Why Choose Dr Daniel Meyerkort and Perth Orthopaedic & Sports Medicine?

Dr Daniel Meyerkort is a fellowship-trained orthopaedic surgeon with special expertise in sports ankle surgery. He has successfully treated numerous athletes and active patients with syndesmosis injuries using the latest minimally invasive techniques, including the Arthrex Double TightRope.

At Perth Orthopaedic & Sports Medicine, we offer:

  • Access to leading physiotherapists across WA

  • Telehealth consultations for regional patients

  • Early surgical availability and same-week acute injury review

  • A tailored approach focused on rapid recovery and long-term outcomes

Syndesmosis injuries require timely and expert management to prevent long-term dysfunction and instability. For mild cases, conservative treatment and physiotherapy can yield good results. However, for unstable injuries, surgical intervention – offers superior outcomes with earlier return to function.

Personalised Orthopaedic Care in Perth

Dr Daniel Meyerkort and the team at Perth Orthopaedic & Sports Medicine Centre are leaders in ankle injury management, combining state-of-the-art surgical techniques with comprehensive rehabilitation programs to help patients recover stronger and faster.

For expert assessment of ankle syndesmosis injuries, contact Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine today.