DECEMBER 2012 |฀Volume฀35฀•฀Number฀12 n Feature Article abstract Full article available online at Healio.com/Orthopedics. Search: 20121120-13 Isolated syndesmosis injuries often go unrecognized and are diagnosed as lateral ankle sprains; however, they are more disabling than lateral ankle sprains. The reported in- cidence of isolated syndesmosis injuries in acute ankle sprains ranges between 1% and 16%. When ankle disability lasts for more than 2 months after an ankle sprain, the incidence increases to 23.6%. Diagnostic workup may include stress radiographs, magnetic resonance imaging, or diagnostic arthroscopy. A simple stress test radiograph may reveal an unstable grade III syndesmosis sprain that may go unrecognized on plain anteroposterior and mortise or lateral radiographs of the ankle. The duration of symptoms in isolated syndesmosis injury is longer and more severe, often leading to chronic symptoms or ankle instability requiring operative stabilization. This article describes the clinical presentation, injury classification, and operative sta- bilization techniques of isolated syndesmosis injuries. The authors performed their pre- ferred operative stabilization technique for isolated syndesmosis injury—arthroscopic debridement of the ankle with syndesmotic stabilization with a syndesmotic screw— in 4 patients. All patients were evaluated 1 year postoperatively with subjective and objective assessment scales. Three of 4 patients showed good improvement of general subjective ankle symptoms and subjective ankle instability rating and a high Sports Ankle Rating System score after 1 year. Dr Valkering is from the Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, and Drs Vergroesen and Nolte are from the Department of Orthopedic Surgery, Spaarne Hospital, Hoofddorp, The Netherlands. Drs Valkering, Vergroesen, and Nolte have no relevant financial relationships to disclose. Correspondence should be addressed to: Kars P. Valkering, MD, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands (kars.valkering@gmail.com). doi: 10.3928/01477447-20121120-13 Isolated Syndesmosis Ankle Injury KARS P. VALKERING, MD; DIEDERIK A. VERGROESEN, MD; PETER A. NOLTE, MD, PHD e1705 Figure 1: Intraoperative photograph showing the ruptured anterior syndesmosis. 1 Figure 2: Intraoperative photograph showing the placement of the syndesmotic screw. 2