Episode 192: Stabilizing the Syndesmosis: Modern Approaches to a Common Problem with Dr. Kevin Martin - Live at AOSSM 2026
High ankle sprains and syndesmosis injuries can be some of the most challenging ankle injuries to diagnose and manage—particularly when instability requires surgical intervention.
In this special episode of The Sports Docs Podcast LIVE from the AOSSM Annual Meeting in Seattle, hosts Ashley Bassett, MD, and Catherine Logan, MD, sit down with Kevin Martin, DO, Orthopaedic Surgeon at The Ohio State University, to discuss modern approaches to syndesmosis stabilization.
The conversation explores how surgical management has evolved from traditional rigid screw fixation toward dynamic stabilization strategies and what that evolution means for reduction accuracy, rehabilitation, and return to sport.
Dr. Martin shares his approach to determining when a syndesmosis injury requires surgery and walks listeners through important technical considerations for achieving and maintaining an anatomic reduction. The discussion covers practical surgical pearls and pitfalls, including reduction techniques, clamp positioning, tunnel placement, button seating, and avoiding syndesmotic malreduction.
The group also discusses how surgeons determine when additional fixation may be beneficial, including the decision to use one versus two dynamic fixation constructs in athletes, high-energy injuries, and more rotationally unstable patterns.
Later in the episode, the conversation turns to postoperative rehabilitation and return-to-sport progression, including how injury severity and associated fractures influence decisions surrounding range of motion, weightbearing, running, cutting, and return to competition.
Finally, the episode explores modern options for managing syndesmosis injuries associated with distal fibula fractures, including intramedullary fibular fixation and how implant design continues to evolve to support minimally invasive fracture fixation and syndesmosis stabilization.
In This Episode, We Discuss:
When syndesmosis injuries can be treated nonoperatively—and when surgery is indicated
Identifying syndesmotic instability in athletes
The evolution from rigid fixation to dynamic syndesmosis stabilization
Advantages and limitations of traditional syndesmotic screw fixation
Why anatomic reduction remains the most important step in successful syndesmosis surgery
Surgical pearls for avoiding syndesmotic malreduction
Clamp positioning and the risks of over-compression
Tunnel placement and implant positioning considerations
One versus two fixation constructs: when is additional stabilization necessary?
Managing rotational instability and high-energy injury patterns
Postoperative rehabilitation and return-to-sport progression
Treating syndesmosis injuries associated with distal fibula fractures
Intramedullary fibular fixation as an alternative to traditional plate fixation
Emerging technology and the future of syndesmosis stabilization
Key Takeaway
Successful treatment of syndesmosis injuries starts with recognizing instability and achieving an accurate anatomic reduction. As fixation technology and surgical techniques continue to evolve, surgeons have more options to balance stability, physiologic motion, rehabilitation, and return to sport.
This episode of The Sports Docs Podcast was recorded LIVE at the AOSSM Annual Meeting in Seattle and is sponsored by Arthrex.
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