This prospective cohort study demonstrates that immediate clinical assessment, including injury history, physical examination, and syndesmosis-specific tests, provides significant diagnostic accuracy for detecting partial or complete syndesmosis injuries in athletes presenting within 7 days of an acute ankle injury. Overall clinical suspicion based on combined findings showed high sensitivity and specificity when compared to MRI as the reference standard.
Background
Acute ankle sprains are common sports injuries affecting various ankle ligaments, with lateral ligament ruptures being most frequent. Syndesmosis injuries, though less common, are challenging to diagnose clinically, especially in the acute setting. Previous studies have reported conflicting diagnostic values for physical examination tests, possibly due to differences in timing and patient populations. Accurate early diagnosis is critical to guide appropriate management and prevent chronic instability.
Data Highlights
Parameter
Reported Sensitivity (%)
Reported Specificity (%)
Physical exam for lateral ligament injury within 2 days
71
33
Physical exam for lateral ligament injury after 5 days
96
84
Syndesmosis tests in ED within 24 h (previous study)
14–56
48–83
Tenderness of anterior syndesmosis (within 7 days)
92
Not specified
Squeeze test specificity (within 7 days)
Not specified
88
MRI sensitivity for AITFL injury
100
93
Key Findings
Immediate clinical assessment within 7 days post-injury can reliably detect syndesmosis injuries in athletes.
Injury history and physical examination combined with six standardized syndesmosis tests improve diagnostic accuracy.
Overall clinical suspicion using the modified West Point grading system correlates well with MRI findings.
Some syndesmosis tests, such as tenderness of the anterior syndesmosis and the squeeze test, show high sensitivity and specificity respectively.
Clinical examination performed by orthopedic surgeons or sports medicine physicians without prior calibration reflects real-world diagnostic performance.
Clinical Implications
Clinicians evaluating acute ankle injuries in athletes should perform a thorough injury history and physical examination including specific syndesmosis tests to improve early detection of syndesmosis injuries. Utilizing an overall clinical suspicion grading system can guide decision-making and the need for advanced imaging. Early and accurate diagnosis facilitates timely management to prevent long-term complications.
Conclusion
Immediate clinical assessment combining history, physical examination, and syndesmosis-specific tests demonstrates significant diagnostic accuracy for syndesmosis injuries in athletes. This approach supports effective early diagnosis and management in the acute setting.
References
van der Ent et al. 2024 -- Immediate clinical assessment of syndesmosis injuries demonstrates significant diagnostic accuracy
by Thomas P. A. Baltes, Omar Al Sayrafi, Javier Arnáiz, Maryam R. Al-Naimi, Celeste Geertsema, Liesel Geertsema, Louis Holtzhausen, Pieter D’Hooghe, Gino M. M. J. Kerkhoffs, Johannes L. Tol
