Effectiveness of the TightRope® Fixation in Treating Ankle Syndesmosis Injuries: A Critically Appraised Topic.

Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope™ ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope™ fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope™ syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope™ fixation system in place of the metallic screw following ankle syndesmosis injury.

Does the FIFA 11+ Program Prevent Hamstring Injuries in College-Aged Male Soccer Players? A Critically Appraised Topic.

Clinical Scenario: Hamstring injuries are the most prevalent lower-extremity injury among soccer players. The Fédération Internationale de Football Association (FIFA) has addressed this issue by developing the FIFA 11+ program, which is focused on improving strength and decreasing the incidence of lower-extremity injuries in the sport. This critically appraised topic focuses on this program as well as one of its components, the Nordic hamstring exercise, in the prevention of hamstring injuries. Clinical Question: Does the FIFA 11+ program prevent hamstring injuries in college-aged male soccer players? Summary of Key Findings: Four studies were selected to be critically appraised. The PEDro checklist was used to score the articles on methodology and consistency. All 4 articles demonstrated support for the clinical question. Clinical Bottom Line: There is moderate evidence to support the use of the FIFA 11+ program and Nordic hamstring exercise as part of a college soccer team's warm-up routine. Strength of Recommendation: Grade B evidence exists in support of incorporating the FIFA 11+ program to reduce the incidence of hamstring injuries in male college soccer players.