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FREY Alain, PAPON Pierre

Medical Department of INSEP, 75012, PARIS, FRANCE

Title: Prospective study of ankle injury in high level athlete in INSEP: incidence of the lesion of the distal tibio-fibular syndesmosis (DTFS).


FREY Alain, MD, 53 years old, is an emergency and sport medecine doctor. Since 2012, he’s the chief od the Department Medical of the French National Sport Institute (INSEP) in Paris. Before he was the chief of  the emergency departement in Poissy, hospital near Paris. He works also in the french federation of Judo and modern Pentathlon and he’s member of the french  medical committee of the national olympic commitee. He’s participated in a lot of congress in Emergency and Sport medecine.

PAPON Pierre, MD, 33 years old, is a young sport medical doctor working at INSEP.     


Purpose of the study:The lesion of DFTS are often unknow during  ankle trauma. We wanted to see the incidence of this lesion and to validate the specific clinical signs.

Materiel and method:Between March, 2015 and March, 2016, we included any ankle trauma of our high-level sportsmen. They all benefited from an  initial clinical examination diligently of the Ottawa rules and a ultrasound  realized in 3 days. If there was a lesion of the AITFL in ultrasound, a MRI and stress radiographies were realized. A protocol of treatment was proposed: functional treatment if distension of AITFL, hiking boots if isolated rupture of AITFL, plaster if rupture of AITFL and lesion of  inter osseous membrane without diasthasis, surgery if diasthasis. All were seen again to day 8 with reeducation,  day 30 and between 4 and 6 months after their trauma.

Results:126 ankle sprains were analyzed (77 M, 49 F) with 28 lesion of DFTS (22.2 %). On day 8, the sensibility and the specificity of the main clinical signs are respectively: AITFL palpation ( 0.94/0.86), lateral rotation test (0.72/0.97), dorsal flexion compression test (0.72/0.97), squeeze test (0.24/0.97). In ultrasound as in MRI, besides the AITFL, are observed 8 inter-osseous membranes lesions, one PITFL lesion, 2 anterior MCL lesion and 8 TFA lesion. 15 functional treatment, 8 hiking boots and  5 plaster. The return to sport at the same level was made between 3 and 12 weeks according to the gravity.

Conclusion:This ligamentary lesion is frequent and affects several sports. The clinical examination repeated to day 8, coupled with ultrasound, seems to be the best compromise to adapt the management.