Clin Orthop Surg.  2025 Apr;17(2):324-330. 10.4055/cios24338.

Comparison between Suture-Button Technique with Syndesmotic Repair and Screw Fixation Technique for Complete Ankle Syndesmotic Injury: Biomechanical Cadaveric Study

• Lee HS
• Kim SH
• Young KW
• Kim WJ
• Cheon DI
• Won SH
• Lee SH
• Choi SJ
• Lee YK

• KMID: 2565835
• DOI: http://doi.org/10.4055/cios24338

Abstract

Background
The tibiofibular syndesmosis is essential for preserving the stability of the ankle. Acute syndesmotic injuries with evident or latent instability usually warrant surgical interventions. This cadaveric study examines and compares biomechanical characteristics between the following treatments for syndesmosis injuries: suture-button fixation plus syndesmotic repair and screw fixation.
Methods
The lower extremities of 10 cadavers disarticulated at the knee joints were used, yielding 20 feet. Ten feet underwent surgery using the suture-button fixation with syndesmotic repair, while the remaining 10 feet underwent surgery using screw fixation. Before surgical treatment of syndesmosis injuries, each cadaveric lower limb underwent preliminary physiological cyclic loading, which was followed by a series of postfixation cyclic loading tests after the surgical procedure.
Results
Our principal finding is that suture-button fixation with syndesmotic repair provided torsional strength comparable to that of screw fixation. The mean failure torque did not differ between the 2 groups, but the rotational stiffness was significantly lower in the suture-button fixation/augmentation group.
Conclusions
Suture-button fixation/augmentation facilitates flexible (physiological) syndesmosis movement and may be a useful alternative treatment for ankle syndesmosis injury.

Keyword

Syndesmosis; Syndesmotic instability; Operative fixation; Flexible fixation; Rigid fixation