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Conclusion

Les lésions de la syndesmose sont relativement fréquentes dans les sports de contact et notamment le judo. Beaucoup de ces traumatismes sont mal identifiés initialement. La suspicion d’une lésion de la syndesmose devant un mécanisme traumatique en rotation latérale permet d’orienter l’examen physique à la recherche d’une douleur sur le LTFAI, d’une rotation latérale douloureuse et d’un squeeze test positif. La méconnaissance du diagnostic initial est source de chronicisation des symptômes. Une fois la suspicion de lésion de la syndesmose évoquée, une analyse précise des clichés radiographiques permettra d’évaluer la stabilité ou non de la lésion et la présence ou non de fracture associée. L’IRM ou l’échographie dans des mains expertes permettra de préciser les lésions de grade II à haut risque d’instabilité. Une prise en charge au stade aigu est indispensable et sera conservatrice en fonction de la stabilité des lésions ou chirurgicale en cas d’instabilité avérée ou occulte. Le délai de traitement et de reprise des activités est plus long que pour une simple entorse du plan latéral isolé. Reste à préciser les modalités chirurgicales consensuelles et le démembrement précis lésionnel des grades II permettant de mettre en évidence des facteurs prédictifs d’instabilité occulte à long terme.

Bibliographie

  1. Gerber J, Williams G, Scoville C et al. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle 1998 ; 19 : 653-60.
  2. Wright R, Barlie J, Suprent D, Matave M. Ankle syndesmosis sprains in national hockey league players. Am J Sports Med 2004 ; 32 : 1941-5.
  3. Hermans JJ, Beumer A, de Jong TA, Kleinrensink GJ. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat 2010 ; 217 : 633-45.
  4. Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 2003 ; 25 : 379-86.
  5. Brown K, Morrison W, Schwetzer M et al. MRI findings associated with distal tibiofibular syndesmosis injuries. Am J Roentgenol 2004 ; 182 : 131-6.
  6. Xenos J, Hopkinson W, Mulligan M, Olson E, Popovic N. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 1995 ; 77 : 847-56.
  7. Norkus S, Floyd R. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train 2001 ; 36 : 68-73.
  8. Haraguchi N, Armiger R. A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am 2009 ; 91 : 821-9.
  9. Wei F, Villwock MR, Meyer EG et al. A biomechanical investigation of ankle injury under excessive external foot rotation in the human cadaver. J Biomech Eng 2010 ; 132 : 091001.
  10. Dattani R, Patnaik S, Kantak A et al. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br 2008 ; 90 : 405-10.
  11. Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med 1991 ; 19 : 294-8.
  12. Vosseller JT, Karl JW, Greisberg JK. Incidence of syndesmotic injury. Orthopedics 2014 ; 37 : e226-9.
  13. Porter DA, Jaggers RR, Barnes AF et al. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med 2014 ; 5 : 173-82.
  14. Switaj PJ, Mendoza M, Kadakia AR. Acute and chronic injuries to the syndesmosis. Clin Sports Med 2015 ; 34 : 643-77.
  15. Hunt KJ, Phisitkul P, Pirolo J, Amendola A. High ankle sprains and syndesmotic injuries in athletes. J Am Acad Orthop Surg 2015 ; 23 : 661-73.
  16. Mak MF, Gartner L, Pearce CJ. Management of syndesmosis injuries in the elite athlete. Foot Ankle Clin 2013 ; 18 : 195-214.
  17. Hunt KJ, George E, Harris AH, Dragoo JL. Epidemiology of syndesmosis injuries in intercollegiate football: Incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004- 2005 to 2008-2009. Clin J Sport Med 2013 ; 23 : 278-82.
  18. Waterman BR, Belmont PJ Jr, Cameron et al. Risk factors for syndesmotic and medial ankle sprain: Role of sex, sport, and level of competition. Am J Sports Med 2011 ; 39 : 992-8.
  19. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma 2012 ; 26 : 439-43.
  20. Lubberts B, van Dijk PAD, Calder JD, DiGiovanni CW. There is no best surgical treatment for chronic isolated syndesmotic instability: a systematic review. J ISAKOS 2016 ; 1 : 250-6.
  21. Frey A, Papon P, Le Garrec S et al. Les atteintes de la syndesmoses tibio- fibulaire distale, une pathologie fréquente chez les sportifs de haut niveau. J Traumat Sport 2018 ; 35 : 61-2.
  22. Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther 1998 ; 27 : 276-84.
  23. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle 1990 ; 10 : 325-30.
  24. Beumer A, Swierstra BA, Mulder PG. Clinical diagnosis of syndesmotic ankle instability: evaluation of stress tests behind the curtains. Acta Orthop Scand 2002 ; 73 : 667-9.
  25. de Cesar PC, Avila EM, de Abreu MR. Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot Ankle Int 2011 ; 32 : 1110-4.
  26. Sman AD, Hiller CE, Rae K et al. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med 2015 ; 49 : 323-9.
  27. van Dijk CN, Longo UG, Loppini M et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 2016 ; 24 : 1200-16.
  28. Takao M, Ochi M, Oae K et al. Diagnosis of a tear of the tibiofibular syndesmosis: The role of arthroscopy of the ankle. J Bone Joint Surg Br 2003 ; 85 : 324-9.
  29. McCollum GA, et al. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc. 2013;21(6): 1328-37.
  30. Scranton PE Jr. Sprains and soft tissue injuries. In: Pfefer G, ed. Chronic ankle pain in the athlete. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000 : 3-20.
  31. Wolf BR, Amendola AA. Syndesmosis injuries in the athlete: When and how to operate. Curr Opin Orthop 2002 ; 13 : 151-4.
  32. van Dijk CN, Longo UG, Loppini M et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016 ; 24 : 1217-27.
  33. Nussbaum ED, Hosea TM, Sieler SD et al. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med 2001 ; 29 : 31-5.
  34. Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med 2007 ; 35 :1833-8.
  35. Forsythe K, Freedman KB, Stover MD, Patwardhan AG. Comparison of a novel FiberWire-button construct versus metallic screw fixation in a syndesmotic injury model. Foot Ankle Int 2008 ; 29 : 49-54.
  36. Gardner R, Yousri T, Holmes F et al. Stabilisation of the syndesmosis in the maisonneuve fracture – a biomechanical study comparing two-hole locking plate and quadricortical screw fixation. J Orthop Trauma 2013 ; 27 : 212-6.
  37. Hovis WD, Kaiser BW, Watson JT, Bucholz RW. Treatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 2002 ; 84 : 26-31.
  38. Thordarson DB, Samuelson M, Shepherd LE et al. Bioabsorbable versus stainless steel screw fixation of the syndesmosis in pronation-lateral rotation ankle fractures: a prospective randomized trial. Foot Ankle Int 2001 ; 22 : 335-8.
  39. Thornes B, Shannon F, Guiney AM et al. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 2005 ; 431 : 207-12.
  40. Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg 2007 ; 15 : 330-9.
  41. Soin SP, Knight TA, Dinah AF et al. Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison. Foot Ankle Int 2009 ; 30 : 346-52.
  42. Wikeroy AK, Hoiness PR, Andreassen GS et al. No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma 2010 ; 24 : 17-23.
  43. Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int 2011 ; 32 : 250-6.
  44. Teramoto A, Suzuki D, Kamiya T et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med 2011 ; 39 : 2226-32.
  45. Naqvi GA, Cunningham P, Lynch B et al. Fixation of ankle syndesmotic injuries: comparison of TightRope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med 2012 ; 40 : 2828- 35.
  46. Storey P, Gadd RJ, Blundell C. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int 2012 ; 33 : 717-21.
  47. Markolf KL, Jackson SR, McAllister DR. Syndesmosis fixation using dual 3.5 mm and 4.5 mm screws with tricortical and quadricortical purchase: a biomechanical study. Foot Ankle Int 2013 ; 34 : 734-9.
  48. Egol KA, Pahk B, Walsh M et al. Outcome after unstable ankle fracture: effect of syndesmotic stabilization. J Orthop Trauma 2010 ; 24 : 7-11.
  49. Vopat ML, Vopat BG, Lubberts B, DiGiovanni CW. Current trends in the diagnosis and management of syndesmotic injury. Curr Rev Muskuloskelet Med 2017 ; 10 : 94-103.
  50. van den Bekerom MP, de Leeuw PA, van Dijk CN. Delayed operative treatment of syndesmotic instability. Current concepts review. Injury 2009 ; 40 : 1137-42.
  51. Lui TH. Endoscopic distal tibiofibular syndesmosis arthrodesis. Arthrosc Tech. 2016 ; 5 : e419-24.
  52. Olson KM, Dairyko Jr GH, Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg Am. 2011 ; 93 : 66-72.

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