Prof. Pieter D' Hooghe, MD, PhD, MBA


Lecture Topic: Syndesmotic Injuries in the Athlete


Dr. Pieter D’Hooghe is the Chief Medical Officer at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar.

As Orthopaedic Surgeon, he specializes in Sports Traumatology of the lower leg with focus on the arthroscopic treatment of athletic Knee and Ankle/Foot injuries.

He holds a Master in Sports Medicine, a Master in Tropical Medicine and an MBA in Sports Management.

He is the Editor of 8 textbooks on Sports Injuries of the lower leg and authors + 40 book chapters and +85 peer-reviewed academic publications. 

As Chairman of the ISAKOS’ Young Professionals Task Force and past Chairman of the Leg, Ankle and Foot Committee, he leads an international panel of experts in the field.

Additionally, as Assistant Professor at Weill Cornell University, he is academically involved in Orthopaedic 

Research and Education while delivering lectures worldwide.

Currently, he also serves as the senior Orthopaedic Consultant for 7 Champions League Football teams in Europe, 1 team in USA and 4 teams in Asia.

Lecture: Syndesmotic Injuries in the Athlete


Injuries to the ankle syndesmosis have demonstrated increased prevalence among athletes of all levels. Syndesmotic injuries occur in athletes at an estimated incidence of 0.05 injuries per 1000 hours of exposure. Impact and collision sports such as soccer, skiing, football, ice hockey, wrestling, and rugby exhibit a higher prevalence of injury. It is also widely recognized that ligamentous syndesmotic injuries result in substantially longer times missed from sport compared to other ankle ligament injuries, are much more likely to require surgical stabilization (Figure ), and are associated with more long-term functional sequelae. Increasing prevalence of a higher risk injury has intensified the focus in recent years on diagnosis and management of syndesmotic injuries in sports medicine and athletic training circles.

There is no current consensus on a return to sport protocol for athletes to return to play following syndesmotic injury. D’Hooghe et al. reported on a large professional soccer registry to study players with Grade IIb and III syndesmotic injuries and collect information on rehabilitation, the time to return to sport-specific rehabilitation, and the time to first official soccer match after injury. They found that out of 110 professional soccer players in the registry, none had participated in an official match at one-month after surgery. Additionally, only 4% of the athletes returned to an official game within two months after surgery. Their data also revealed that the mean time to begin on-field/sport-specific rehabilitation was 37 +/- 12 days, with a mean time of 103 +/- 28 days to the first match after syndesmotic stabilization. 

Although there are clear differences in etiology, mechanism of injury and treatment options/RTP between lateral ligament ankle injuries and syndesmotic injuries, most syndesmotic ankle sprains are still treated by “classic” ankle sprain rehabilitation protocols. 

In order to improve our understanding in syndesmotic ankle sprain rehabilitation, there is a need for validated rehabilitation protocols and post-injury discharge criteria.

In Summary, syndesmotic injuries are increasingly common in the field and court sports. Injury severity, nuanced diagnosis, and long-term functional risk have led to significant advances in diagnosis and management protocols. Indeed, our approach to these athletes has changed considerably, even in the last decade. While there is an ongoing need for additional science to support new surgical stabilization constructs and accelerated return to sport protocols, the current management ethos has evolved toward flexible fixation device constructs and more specified rehabilitation protocols.