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Old 01-20-2010, 04:59 PM   #1
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everest19 HB User
ankle syndesmosis tightrope

Has anyone had any experience with the ankle tightrope fixation as compared to having a syndesmosis screw inserted? My ortho has suggested this instead of the screw. I have done some research and it seems relatively new and I was unable to find any personal experiences so thought this might be a good place to ask!

Thanks in advance!

 
Old 03-09-2010, 04:55 PM   #2
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Re: ankle syndesmosis tightrope

Hello Everest-

Not sure if you have already had this procedure done or not, but I am about 8 weeks out from syndesmosis fixation with a tightrope. I had done a ton of research before having this done, and was not really able to find any type of discussion board about it. I only read research articles and gained information from all 3 doctors I went to for second and third opinions. Just thought I would add information about my procedure so if there is anyone out there in the position I was in, they will be able to read my experience...

My original injury was a lateral ankle sprain, high ankle sprain (syndesmosis) and non-displaced tibia fracture. I did this while landing from a sky-diving jump. I was placed in a cast for 6 weeks NWB for the fracture, and was told that everything else would heal while NWB. Once I got the cast off I started physical therapy and continued with it for about 8 weeks. After going to see my doctor 3 times during those 8 week, was told to just keep going with it for 8 weeks and see if it helps. It did help to a certain amount. I was able to regain my range of motion and some strength, but just had lingering pain in my ankle area. After the 8 weeks of therapy I went back to my DR. and he recommended the tightrope fixation. The fracture was healed and doing well by now. So as I mentioned above, I researched and got second and third opinions, but decided to stick with my original orthopedic Dr. I really like him and felt he was the best fit, having done many of these procedures and having good results with the tightrope.

So I had the surgery along with an extensive cleaning out of the ankle joint area due to fact that scar tissue and impingement had developed. The surgery was done under general and lasted a little over 2 hours. I have maybe a 2 inch incision on the front/lateral part of my ankle from the cleaning out and then some small incisions on the lateral part of my ankle. I was put in a splint following surgery for 10 days and then was put into a purple cast and and to remain NWB for what ended up being a total of 6 weeks. The tightrope can be felt right under the skin and is still tender on the lateral side. The medial button is not tender at all and is feeling good on that side. I have already regained quite a bit of ROM in the last week that I have been doing therapy so that is good. Walking without the boot is painful, but seems to be improving everyday. (I am allowed to walk without boot only when in therapy). It took me about 3 days to completely get rid of the crutches once I was told I could.

I am not sure if anyone would have any questions about this, but I would be more than happy to answer them. I wish I could have had something like this just to gain some insight before the procedure, but this site is amazing and full of great information and experiences.

Sorry for the length!
Ginger

 
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Old 05-28-2010, 07:43 AM   #3
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Joder HB User
Re: ankle syndesmosis tightrope

Interesting post Ginger thank you -

I would like to ask your view, or any other members, I suffered a Weber-C fracture in early Jan with a full syndesmotic rupture. The bone was plated and the syndesmosis fixed with a syndesmotic screw.

I went for an opinion with a specialist in London, who plans to remove the screw and possibly the plate (optional - up to me!) He said that if the ankle is still unstable, he would use the tightrope... on looking at some of the x-rays and contemplating a connection that emerges on the tibial side of the ankle as well, I'm not so keen..

Any views anyone?

J

 
Old 05-29-2010, 05:29 AM   #4
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Re: ankle syndesmosis tightrope

Hey Joder-

Just thought maybe by giving you an update on how things are going with me and that might possibly help you. I am about 5 months post op since the tightrope was inserted. I would say my ankle is about 95% right now. I am a back in the gym running and doing group fitness classes and sports (tennis, racketball, and soccer). with no problem with my ankle. At first I was afraid for side to side movements, but have pretty much gotten over that fear. I was told to wear a brace for 6 months from surgery date. After working out or playing sports sometimes my ankle will be a little sore after doing so, but with some ice it quickly resolves. My DR told me it will continue to improve and that will go away. All in all, I am very very happy with it and happy I decided to have it done. I really hardly notice it anymore and was able to regain almost full ROM (maybe 2-3 degrees off from other side) and full strength. My doctor had told me before the surgery that it was possible that it might feel tight/slightly stiff and that it would probably never feel the same as the other ankle. Well I have neither of those problems, so all in all, I would highly recommend getting the tightrope if you can find a doctor who is willing to do it and that has done it in the past.

Goodluck! Keep me updated on how it goes!
Ginger

 
Old 06-02-2010, 10:51 AM   #5
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Re: ankle syndesmosis tightrope

Thanks so much Ginger - sounds like you have made a great recovery..

I am now 5 months post surgery and am holding off on the martial arts, running etc, because I'm worried the screw might shear off! sounds like the tightrope was a good idea for you.. I don't think it was available for me at the time of the accident.

can I ask - I believe this thing goes right through the tib and fib? - so can you feel where the button comes out on the tibia side. Does it come out right on the ankle bone the way it looks in the pictures?

I have a plate along the fibula, which I will probably have removed as I think it will interfere with my ski boot and I don't think the button will bother me on the fib side.

Sorry to ask so many questions - I guess I am anxious now at disrupting the whole thing as it seems to have healed so well.

Thanks for your help

Joder

 
Old 06-02-2010, 05:17 PM   #6
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Re: ankle syndesmosis tightrope

Hi Joder-

Don't worry about the questions! I am more than happy to answer them! I think the tightrope is so interesting and it will be great to hear how it goes if you do decide to have it done!

In terms of the buttons on both sides, I can feel them thru my skin on both the tib and fibula side. The button on the fibula side is much more noticible than the medial button though. My doctor told me the tightrope in general is much less prominent than a screw, so that would probably be great for you. I was also worried about my ski boots with the tightrope because I was having problems with the brace initially. When I was first started wearing the brace I was having a lot of problems with the lateral button. The brace felt like it was irritating the button/ incision area. Eventually in a couple of weeks that went away and now I don't notice it, so I am hoping when the winter weather rolls around my ski boot will be alright.

From the beginning all of my pain has been over the lateral button. I have never once had pain on the medial side. I am not sure if this is because the incision in only on the lateral side or what, but it is opposite to the pain where my doctor said most people have problems.

Interesting that I was raving about the button a couple days ago and today I am having some pain. I really did a ton over the weekend, sports wise, and must have overdone it. It really has been a couple weeks since I have had any pain so hopefully it will return that way soon!!

Why did you go to the specialist in London? Are you having problems with the plate and everything or were you just looking to get everything out? I know that you said things healed up really well, so just curious as to your reasoning to seek out a specialist.

 
Old 06-04-2010, 06:52 AM   #7
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Re: ankle syndesmosis tightrope

sorry it's painful - I guess it is up and down isn't it..

well in my case - it has healed well so far.. I have been told that the syndesmosis crew does need to come out as it reduces the overall flexibility of the ankle and can break under stress.

I didn't have much faith in the local guys as they told me "you don't need any physio for it.." which I knew to be wrong, and seemed quite dismissive. so I went for a second opinion.

I think most surgeons just take the screw out and hope for the best, but I guess this guy is extra conservative, which is why he said he would use the tightrope if the syndesmosis was not stable now. I supose if it hasn't mended the joint can be unstable...

He also noted that my syndesmotic screw only goes half way through the tib - he said many surgeons put it right through precisely in case it does snap off - ouch!

I quite fancy the plate out as well, although it doesn't really bother me. I ski and dive so it shouldn't be a problem for those, but I think it might be for the martial arts, eg if someone blocked a kick hard...

If I'm lucky I won't need the tightrope, but I don't know yet.. I wasn't worried at all about the initial procedure...

funny really - but then again I'm not a skydiver so I'm quite cautious!! :0)

speak soon

Joder

 
Old 06-15-2010, 03:07 PM   #8
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Re: ankle syndesmosis tightrope

Hi All-

I too have had a tightrope put in. I am about 6 months post-op right now. It really is becoming disappointing for me because I really felt as though things were going well, but now feel as though I am having the same ankle impingement issues I had before surgery. The tib-fib area was cleaned out with a open procedure ( not scope), and was feeling fine until a few weeks ago. I feel like the pain in the same, but then again it is different. I am not sure how I am even going to describe it to my doctor as soon as I gather up the courage to make an appointment. Not to mention that I am also having pain in the back of my ankle on what seems to be both sides of my achilles. I did have tenosynovitis of my peroneal tendons, but not bothersome enough to where I was wanting another incision. It seemed to have healed or recovered during the 6 weeks I was non-weightbearing but I don't even know if this is what is causing the pain in the back. UH! very frustrating.

As for the tightrope... It seems like it is doing ok for me. I think apart from a lot of other people, it is the only metal I have in my ankle. My break was a nondisplaced tibia fracture which didn't require any internal fixation. I didn't have the tightrope put in until about 5 months after my injury which just wasn't healing on it's own or properly. But so far it really isn't bothersome unless I am doing some pretty physical activities. It can usually be calmed down with some advil and good ole' ice (like you said Ginger)!!

Hope everyone is doing well!

 
Old 06-18-2010, 03:55 PM   #9
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Joder HB User
Re: ankle syndesmosis tightrope

Hi Cate,

so sorry to hear what you are going through.. mine is not much by comparison

silly question - are you getting some top quality physiotherapy? I found that it really helped me - just to point out the simple exercises you can do..

I hope it all settles down for you - do speak to the doc though or maybe switch if you're not getting any attention...

counting down 2 wks to my op... can't understand why I feel it's such a big deal

all the best

J

 
Old 06-18-2010, 06:57 PM   #10
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Re: ankle syndesmosis tightrope

Yes, I had about 9 weeks of PT following the nonweightbearing stage. Things really improved in that time while I was there, but have just been declining since I started back up with things. Maybe I am just expecting too much from my ankle. I was warned that it would never feel the same, so maybe this is it. I hope my doctor doesn't want to send me back there seeing as I also did about 7-8 weeks before my surgery to try and get things to improve. Thats more than enough PT for me.

Joder, be sure to keep us posted on how you are doing post- second surgery. Will they decide in the OR if you need the tightrope? Keep us all up to date on how things are progressing for you. Best of luck

 
Old 06-19-2010, 04:46 AM   #11
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Re: ankle syndesmosis tightrope

Thanks Cate,

yes, he will decide in the OR what to do... I'm not sure what his decision criteria wil be - I guess he will stress the syndesmosis by pushing the ankle hard and see what happens - that's what worries me really..

will let you know how it all goes..

speak soon

J

 
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