Use of syndesmotic suture button fixation has gained in popularity for treating an injury to the tibiofibular syndesmosis. Biomechanical fixation stability with suture button device (TightRope; Arthrex, Naples, FL) placed at 4 distances from the tibiotalar joint line (0.5, 1.5, 2.5, and 3.5 cm) and 3 trajectories (anterior, medial, and posterior) were studied using cadaveric lower extremities with created syndesmotic injuries. Fixation placed at 0.5 or 1.5 cm from the joint line in medial or posterior trajectories resulted in the lowest increases in fibular rotation. More proximal or anterior placements led to increased fibular motion and decreased rotational stability.

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Optimal Tightrope Positioning for Adequate Syndesmotic Stabilization in Simulated Syndesmotic Injuries

🧠 Key Points

Syndesmotic suture button placement 0.5–1.5 cm from the joint line provides the most rotationally stable fixation.
Medial and posterior trajectories are more stable than anterior placements.
Proximal placements beyond 1.5 cm increase fibular motion and reduce stability.
Ankle width changes were minimal but increased slightly with anterior or proximal placement.
Biomechanical cadaveric testing simulates in vivo weightbearing and rotational loads.

Foot & Ankle Orthopaedics
(2025)

DOI: 10.1177/24730114251342243