J Korean Foot Ankle Soc.  2018 Dec;22(4):161-165. 10.14193/jkfas.2018.22.4.161.

Comparision between Syndesmotic Screw Fixation and Knotless Tightrope® Fixation on Ankle Fractures with Distal Tibiofibular Syndesmosis Injury

  • 1Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea. kiga9@hanmail.net


A distal tibiofibular syndesmosis injury with an ankle fracture is usually fixed with syndesmotic screws. Knotless Tightrope® has been used as an alternative procedure because of the fewer reported complications. Therefore, this study compared the two surgeries.
Forty-two patients, who underwent syndesmotic screw fixation, and 34 patients, who underwent Knotless Tightrope® fixation for distal tibiofibular syndesmosis injury from February 2014 to February 2016, were analyzed retrospectively. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion of ankle at 1 year after surgery, tibiofibular clear space, and tibiofibular interval at preoperative, postoperative and 1 year after surgery were investigated.
The VAS score, AOFAS score and radiographs were similar in the two groups. Knotless Tightrope® showed better results in complications and plantarflexion.
Knotless Tightrope® fixation is a useful treatment that does not show a difference in fixation strength and clinical outcome. Knotless Tightrope® fixation also has an advantage in the range of motion and complications.


Ankle fracture; Syndesmotic injuries; Bone screws; Suture anchors

MeSH Terms

Ankle Fractures*
Ankle Injuries
Ankle Joint*
Bone Screws
Range of Motion, Articular
Retrospective Studies
Suture Anchors


  • Figure 1. Examples of surgery using syndesmotic screw fixation. Preoperative radiographs (A), postoperative radiographs (B), and 12 months after surgery (C).

  • Figure 2. Examples of surgery using Knotless Tightrope® fixation. Preoperative radiographs (A), postoperative radiographs (B), and 12 months after surgery (C).

  • Figure 3. Example of broken screw after syndesmotic screw fixation.

  • Figure 4. Example of bone erosion (arrow) after Knotless Tightrope® fixation.


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