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Syndesmosis Injury

Syndesmosis ankle injury became a the “buzz” term of the 2020 AFL season. The number of Ankle syndesmosis injuries increased 4x in 2020. Even with a shortened season. There were 21 syndesmosis injuries last year. Dion Prestia, Toby Nankervis, Aaron Naughton, Jake Stringer and Andy McGrath were just a few players to miss games.

This season has once again seen a spate of syndesmosis injuries, otherwise known as a high ankle sprain. Both Patrick Dangerfield and Adam Treloar underwent ankle surgery following syndesmosis injuries. This week, we learned that Richmond premiership players, Noah Balta and Nathan Broad have now joined the list of AFL players needing ankle surgery due to a high ankle sprain.

Why has there been an increase in syndesmosis injuries in the AFL?

There are a few things that may have had a role to play. The game has become quite fast-paced with recent rule changes. Interpretations of these rules seems to be increasing the speed of the game. An interrupted and the shortened pre-season, along with a condensed 2020 season has possibly led to reduced conditioning and training continuity. These are all possible factors for an increase in syndesmosis injuries in the AFL.

So what is a syndesmosis ankle injury/sprain?

A syndesmosis ankle injury is a little different to your regular, run of the mill ankle sprain. A syndesmosis sprain is also known as a “high ankle sprain”. It is quite a lot more serious. Ankle sprains are among some of the most common injuries. Up to 50 games are missed across the competition each year because of ankle injuries. The difference between a regular sprain and a syndesmosis injury is the location of the injury. High ankle sprains vary from the typical inversion sprains/ A high ankle sprain involves the syndesmosis ligament. Syndesmosis injuries are less common than the typical ankle sprain but can be more traumatic,

Syndesmosis is a network of ligaments and fibrous structures that bind the bones of the lower leg (tibia and fibula) together. This provides shock absorption and stability through the ankle. Injury to these structures, compromises the stability of the ankle and allows for the ankle to wedge between the two leg bones.

Syndesmosis injuries occur when a foot is planted firmly on the ground and an external force (i.e. being tackled) moves the leg around or over the foot. Trauma to these structures can lead to swelling above the ankle, pain and can potentially lead to bone reactions. As pictured after his injury, Adam Treloar was placed in a CAM boot. The moon boot helps stabilise the ankle until imaging can confirm the extent and severity of the injury.

Conservative Management:

Immobilisation is the primary treatment if the injury is considered to be a mild syndesmosis sprain/tear. Protecting the injured structures and tissues is crucial. Offloading via a moon boot and crutches prevents unwanted movement. It prevents weight and force through the ankle joint allowing the injury to heal. Ice and anti-inflammatory medication is also effective and minimising swelling. Following a period of rest and offloading, substantial rehabilitation to restore strength and ankle range of motion is required. Some players need 8-10 weeks to fully recover from a syndesmosis injury. Surgery may be recommended if conservative management fails. If offloading and rehab isn’t enough to improve ankle stability and reduce the separating of the lower leg bones.

Surgical Management:

The weekend’s syndesmosis injuries, much like Adam Treloar’s, will require surgery. Both players can expect lengthy stints on the sidelines. Surgery consists of inserting a screw or wire to hold the tibia and fibula together. The screw or wire replace the syndesmosis structure and stabilise the lower leg. Should an ankle fractures also be present, these can be repaired while pinning the lower limb bones. Rehab is also required, strengthening the surrounding structures to allow return to sport.