JOT - 2026-08-01 - Journal Article; Case Reports
Ankle Syndesmotic Injury With Posterior Tibial Tendon Rupture.
Lezak BA, Mercer NP, Lowe DT, Egol KA
Topics
Key Takeaway
A single case of isolated ankle syndesmotic injury with concomitant posterior tibial tendon rupture was managed with primary repair of both structures, highlighting a rare injury pattern requiring heightened soft-tissue vigilance.
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Summary
This case report describes an isolated ankle syndesmotic injury without fracture presenting with concomitant posterior tibial tendon rupture, an exceedingly rare combined soft-tissue injury pattern. Comprehensive clinical and advanced imaging evaluation identified the tendon pathology, which was treated with primary repair alongside syndesmotic stabilization. The authors advocate for a high index of suspicion for associated soft-tissue injury in ligamentous syndesmotic disruptions occurring outside the typical fracture context.
Key Limitation
A single case provides no outcome data, incidence estimate, or comparative management information, making evidence-based practice change impossible.
Original Abstract
Isolated ankle syndesmotic injuries are uncommon and are typically discussed in the context of athletic high ankle sprains; however, concomitant rupture of the posterior tibial tendon represents an exceedingly rare injury pattern. This case highlights the importance of maintaining a high index of suspicion for associated soft-tissue pathology in patients presenting with syndesmotic instability in the absence of fracture. This case underscores the need for comprehensive clinical and imaging evaluation of isolated syndesmotic injuries and supports primary tendon repair when rupture is identified.