High ankle sprains are common injuries in sports and are infamous for having a lengthy recovery process. The incidence of high ankle sprains has been reported to be as much as 10% of all ankle sprains. While a high-ankle sprain is less common than a regular ankle sprain, it is usually a more significant injury that can lead to a long absence from sports and other physical activities. In the most severe cases, surgery may be indicated and suture-button fixation, also known as TightRope™ Fixation, has been developed to allow for potential earlier rehabilitation and return to sport and function.
Syndesmosis Injuries
High ankle sprains happen when a person experiences a high-energy rotatory force on the ankle. A high ankle sprain is also referred to as a syndesmotic injury. The syndesmosis is a strong band of ligaments that connects the fibula to the tibia at the level of the ankle joint. Given that these ligaments are quite strong, it usually takes a significant amount of energy to cause an injury. Typically, these injuries are most prevalent in high energy sports such as football or basketball, although they can also occur from falls and car accidents.
These injuries can cause difficulty with weight bearing and pain, swelling, and weakness about the ankle. In severe cases, the high ankle ligaments can tear, which leads to malalignment and instability of the tibia and fibula bones as they join at the ankle joint. Surgery is needed in these severe cases to restore alignment and stability to the ankle joint. The ligaments can be stabilized surgically with a suture-button device.
What is Suture-Button (TightRope™) Surgery?
Syndesmotic injuries of the ankle usually result from severe external rotation of the ankle. Historically, treatment for high grade tears has involved fixing the tibia and fibula together at their articulation at the ankle joint with use of a metal screw. This is called syndesmotic screw fixation. A screw is used to stabilize the injured ankle while the torn ligaments and any associated broken bones heal. The screw’s rigidity can lead to restriction in certain ankle movements during the early stages of recovery. Once the ankle injury heals, a second surgery is often required to remove the syndesmotic screw.
Suture-button fixation was developed as an alternative to avoid common screw complications such as stiffness, screw breakage, and the need for a second surgery to remove the screw. Fixation with the suture-button consists of strong suture that spans across the tibia and fibula through a tunnel drilled between the two bones. Once the suture-button is tightened into place, it is held in position with a small metallic button on either side of the ankle. Studies have shown that suture-button fixation allows for improved ability to guide the reduction of the tibia and fibula back into proper position for adequate healing of the ligaments.
Because it is less rigid than the screw, studies have also demonstrated the suture-button allows for more adequate biomechanical motion of the ankle joint, and therefore better potential for early rehabilitation. The suture-button typically does not need to be removed once it is placed.
Signs and Symptoms of a High Ankle Sprain
The difficulty with these types of injuries is that they are often associated with severe lateral or medial ankle sprains or fibular fractures. However, in an isolated high ankle sprain, the athlete or person may experience the following symptoms:
- Point tenderness over the anterior aspect of the lower leg and ankle joint
- Pain with weight-bearing
- Pain with passive dorsiflexion
- Pain with passive external rotation
- Mild to moderate swelling in lower leg above ankle
If a syndesmotic ankle injury is suspected, the patient’s lower leg, ankle and foot should be immobilized and radiographs should be obtained in concert with evaluation by an orthopedic surgeon. This evaluation involves a patient history, a physical exam with possible stress testing of the syndesmosis, and weight-bearing x-rays. Sometimes more advanced imaging such as a CT scan or an MRI is needed.
Grades of High Ankle Sprains
Syndesmotic (high) ankle sprain injuries typically take longer to heal than the more common low ankle, ligamentous sprains. There are three grades to high-ankle sprains.
Grade 1 is a simple sprain and involves mild stretching of the ligaments.
Grade 2 is a moderate sprain and means the ligaments have partially and incompletely torn.
Grade 3 is a severe injury where the ligaments have completed ruptured leading to instability of the tibia and fibula articulation at the ankle joint requiring surgical intervention.
Advantages of Suture-Button (TightRope™) Fixation
Suture-button fixation allows for relatively quicker recovery time, which has made it a very attractive procedure for surgeons and patients alike. When compared to syndesmotic screw fixation, suture-button fixation has the following advantages:
- Acts as a tool to aid the reduction of the injured portion of the ankle joint.
- Allows normal motion at the syndesmosis
- Reduces the risk of pain caused by hardware
- Eliminates the possibility of screw breakage
- Allows earlier weight-bearing and return to motion and activity
- Prevents the need for a second surgery
Cowboys’ Tony Pollard Has TightRope™ Surgery for His Injury
Dallas Cowboys running back Tony Pollard was forced to exit the Divisional Round game against the 49ers early after suffering an ankle injury. The official diagnosis determined Pollard sustained a high-ankle sprain in the loss to the Niners, and now the running back, who could hit free agency this offseason, has undergone surgery on his ankle.
Pollard suffered the injury with 1:24 left in the first half when 49ers defensive back Jimmie Ward landed on his ankle while making the tackle. Pollard was carted to the X-ray room with an air cast on his leg and ultimately diagnosed with a severe ankle injury. Days after the injury, Pollard underwent TightRope™ surgery as part of the procedure to restore stability to his ankle.
Pollard is expected to be fully healed in time for the start of training camp next season. Current Miami Dolphins quarterback Tua Tagovailoa underwent a similar surgery while playing at the University of Alabama and Tennessee Titans quarterback Ryan Tannehill also had the procedure recently.
Not Just for Athletes
The desire for a faster recovery and shorter rehabilitation is not limited to high-level athletes. Everyone wants to return to normal quickly. An earlier return to your job, your hobbies, and your everyday life is always the goal.
Ask Your Doctor
A high ankle sprain can be painful and can lead to significant functional loss and disability. Suture-button surgery, if needed, can help you return to optimum functional mobility as quickly as possible.
To learn more about this procedure or to schedule an appointment with one of our specialists, call us at 800-698-1280.
