Syndesmotic Suture Button Fixation Results in Higher Tegner Activity Scale Scores When Compared to Screw Fixation: A Multicenter Investigation

CATEGORY: Ankle INTRODUCTION/PURPOSE: Injuries of the syndesmosis may occur in isolation or association with rotational ankle fractures. The use of suture button 'tight-ropes' versus metal screws for fixation across the syndesmosis has become a highly debated topic. Previous authors have compared subjective, functional, and radiographic outcomes between the two fixation methods with good outcomes reported. The primary aim of this study is to compare clinical outcomes of syndesmotic suture button fixation versus syndesmotic screw fixation for operative management of syndesmotic injuries. A secondary aim is to determine failure rates of both fixation techniques requiring revision syndesmosis surgery. We hypothesize that there will be no difference in subjective outcomes or activity scores when comparing screw versus suture button. This study is to improve patient care and outcomes. METHODS: In this multi-center, retrospective cohort study, we identified patients with syndesmotic injuries who underwent surgical treatment at two separate academic referral centers from 2010 through 2017. All patients were diagnosed by attending orthopaedic surgeons at the participating study sites, and where their syndesmotic injuries were treated with either suture-button fixation or metal screw fixation based on surgeon preference. Patients were matched by age, gender, and OTA fracture classification. The primary subjective outcome measure was the Tegner activity level, and the secondary subjective outcomes measures were the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) subscale, FAAM sport subscale, and patient satisfaction score. The primary objective outcomes included failure and reoperation rate. RESULTS: 41 patients treated with a suture button (71% male, mean age 39.7 years) and 21 patients treated with metal screws (67% male, mean age 43.7 years) were included in the study. Patient demographics were similar between groups. There was no significant difference in FAAM ADL scores between patients based on surgical procedure for the treatment of a syndesmosis injury (suture button versus metal screw fixation), t (50) = 1.373 (p =0.176). There was a significant difference in Tegner activity scale scores, with patients who underwent suture button fixation reporting significantly higher Tegner activity level scores on average than those who underwent syndesmosis repair with screw fixation (U = 141, p =0.002) (Figure 1). CONCLUSION: In this multi-center study, we report higher mean Tegner activity scale scores in patients treated with suture button fixation when compared to patients treated with metal screws for unstable syndesmotic injuries. Patients in both treatment cohorts reported similar FAAM ADL scores. The authors believe that both syndesmotic fixation techniques are acceptable in the treatment of syndesmosis of injuries, but recommend consideration given to suture button fixation in patients with higher activity levels.