Patient-Reported Outcomes, Patient Satisfaction, and Return to Play After Surgical Treatment of Syndesmosis Injuries in Competitive Athletes
Jeffrey R. Ruland, Margaret G. Mercante, Wendy M. Novicoff, M. Truitt Cooper, Joseph S. ParkBackground
Few studies have investigated return to play after surgical stabilization of syndesmotic injuries without fracture with minimal data on patient-reported outcome measures. The purpose of this study was to evaluate patient-reported outcomes, patient satisfaction, and return to play after surgical repair of syndesmosis injuries in competitive athletes.
Methods
A retrospective review of competitive athletes who underwent surgery for an unstable syndesmosis was performed. Patients were excluded if they were not competitive athletes or had the presence of a concomitant fracture. Patient-reported outcome measures were collected via telephone questionnaires. These included the Foot and Ankle Ability Measure (FAAM) Sports Subscale as well as 7 other questions regarding subjective assessment of function, patient satisfaction, and return to play.
Results
A total of 29 ankles in 28 competitive athletes were included. Twenty-four of 28 (86%) patients were male, and 4 of 28 (14%) patients were female. Average age at surgery was 20.7 ± 2.4 (15-24). Twenty-five of 28 (89.3%) athletes completed the post-operative telephone questionnaire with a mean follow-up of 41 months (minimum 9 months). In total, 100% of patients returned to athletic activity. Nineteen of 20 patients (95%) eligible to do so returned to competition, with 16 of 25 (64%) patients reporting a return to pre-injury level of function. The average FAAM-sports score was 29.6 (max 32) ± 3.5. Twenty-four of 25 patients reported post-operative function as normal or nearly normal. Twenty-four of 25 patients reported that they were either very satisfied or satisfied. Patient-reported time of return to unrestricted play was 19.9 ± 9.8 weeks. Injury grade, repair technique, acuity of injury, and concomitant injuries were not associated with prolonged return to play or decreased FAAM scores.
Conclusion
A high percentage of competitive athletes undergoing surgical treatment of syndesmosis injury were able to return to their previous level of competition, with nearly all achieving good-to-excellent outcome scores and satisfaction. Severity of injury, concomitant injury, or repair technique was not found to have an effect on outcomes.
Level of Evidence
IV, single-arm retrospective case series.