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Faster return to play seen after lateral ankle vs syndesmosis sprains in NFL players
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SAN FRANCISCO — Syndesmosis may prove more disabling than lateral ankle sprains for National Football League players, according to recently presented results that analyzed the diagnosis and treatment of these injuries.
“There is typically a direct impact with an external rotation moment and pronation force in syndesmosis as opposed to torsional forces in lateral ankle sprains.” Daryl C. Osbahr, MD, said. “In terms of return to play, it usually occurred in less than a week in the lateral ankle sprain group. However, it required about 2 weeks in those athletes with a syndesmosis sprain.”
Osbahr presented results of the retrospective review at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
Return to play, outcomes
Daryl C. Osbahr
The investigators analyzed prospectively collected data on National Football League (NFL) players who sustained either syndesmosis (36 cases) or lateral ankle sprains (53 cases) during a 15-year period. They compared the diagnosis, treatment and time loss from sports participation between groups and surveyed all 32 team physicians about their management algorithms. “When assessing management options, it was important to differentiate treatment as based upon syndesmosis sprains involving no diastasis, latent diastasis and frank diastasis,” Osbahr said.
Regardless of injury severity, all players in both syndesmosis and lateral ankle sprain groups were able to return to play after nonoperative treatment. Time lost from sports participation for lateral ankle sprains was less than a week, while football players in the syndesmosis sprain group returned to play at an average of 2 weeks.
“Complications included two recurrent syndesmosis sprains and four recurrent lateral ankle sprains; however, all of these players were able to return to play after the recurrent injury utilizing nonoperative treatment,” Osbahr said.
Physician survey results
Syndesmosis sprain management depended upon the severity of injury according to NFL team physicians. For syndesmosis sprains without diastasis, all surveyed team physicians recommended immobilization, Osbahr said, with 28% suggesting a cam walker boot. Most physicians suggested weight bearing as tolerated, with 75% recommending progression to weight bearing as tolerated at 1 week.
The researchers asked the physicians about preoperative predictors of treatment for both injuries based on conventional radiographs or MRIs. The investigators found that 78% of physicians noted that increased tibial fibular clear space on radiographs indicated a need for surgery. Half of physicians said combined anterior or posterior inferior tibiofibular ligament tears on MRI indicated a need for surgery. One-third of physicians said interosseous ligament tears greater than 10 cm required surgery. All of the physicians said frank diastasis indicated a need for surgery.
For those players requiring operative treatment, 60% of team physicians surveyed recommended fixation with two screws. Seventy percent of team physicians said hardware should be removed before return to play; however, 25% allowed contact before hardware removal. Most team physicians (85%) recommended hardware removal between 7 weeks to 12 weeks.
When considering approximate return to play, two-thirds of team physicians said players can return to play within 1 week to 4 weeks in those with no diastasis. For those with latent diastasis, the physicians recommended return to play between 5 weeks to 12 weeks. In cases with frank diastasis, return to play was recommended between 9 weeks to 16 weeks.
For lateral ankle sprains, 72% of physicians suggested rest or taping and 20% recommended a cam walker boot. Most physicians (94%) recommended weight bearing as tolerated. Although 30% of team physicians recommended return to play by 1 week after injury, 80% indicated that players could return to play by 2 weeks. – by Renee Blisard Buddle
Reference:
- Osbahr DC, Drakos M, O’Laughlin PF, et al. Syndesmosis and lateral ankle sprains in the National Football League. Paper #53. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb 7-11. San Francisco.
For more information:
- Daryl C. Osbahr, MD, can be reached at MedStar Union Memorial Hospital, 3333 North Calvert St., Suite 400, Baltimore, MD 21218; email: osbahrd@gmail.com.
- Disclosure: Osbahr has no relevant financial disclosures.