Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes

Clin Orthop Relat Res. 2005 Feb;(431):207-12.


Syndesmosis screws have significant problems including loosening, breakage, the need for removal, and late diastasis. A new technique of syndesmosis fixation is proposed in this study, in which a heavy suture is placed across the syndesmosis, which has been looped and tightened through cortical button anchors on either side of the ankle. Indirect placement of the medial button avoids a medial incision. Sixteen patients had this suture-button fixation in a prospective clinical study. Mean American Orthopaedic Foot and Ankle Society ankle scores were significantly better in patients who had suture-button fixation than in a comparative group of 16 patients who had syndesmosis screw fixation at 3 months (91 versus 80, respectively) and at 12 months postoperatively (93 versus 83, respectively). Return to work was faster (2.8 months in patients who had suture-button fixation versus 4.6 months who had syndesmosis screw fixation), and no patients who had suture-buttons required secondary surgery for implant removal. Axial computed tomography scanning at 3 months showed maintenance of reduction. Suture-button fixation is simple, safe, and effective. Patients have had improved outcomes and faster rehabilitation, without needing routine implant removal. It may become the treatment of choice in patients with a syndesmosis injury.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Ankle Injuries / diagnostic imaging
  • Ankle Injuries / surgery*
  • Bone Screws*
  • Female
  • Fracture Fixation, Internal*
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Prospective Studies
  • Sutures*
  • Tomography, X-Ray Computed
  • Treatment Outcome