Suture-button fixation and anterior inferior tibiofibular ligament augmentation with suture-tape for syndesmosis injury: A biomechanical cadaveric study

2018 
Abstract Background Suture-button (SB) fixation has been widely performed for syndesmosis injuries, but it has been reported unstable in some biomechanical studies. The purpose of this study was to evaluate the stability of the syndesmosis using SB fixation with anterior inferior tibiofibular ligament augmentation using suture-tape (ST). Methods Eight normal fresh-frozen cadaveric legs were used. After initial tests of intact and injured models, SB fixation, SB fixation with ST augmentation, ST augmentation alone, and screw fixation were performed sequentially for each specimen. Loading tests stimulating dorsiflexion, inversion, and external rotation of the ankle joint were performed for each model. The tibiofibular diastasis (TFD) and the fibular rotational angle related to the tibia (FRA) were measured using a magnetic tracking system. Findings In the injured model, both TFD and FRA increased significantly compared with the intact model in all directions ( P P P  > .05). In the screw fixation model, FRA with inversion force at the ankle was significantly decreased compared with the intact model ( P  = .027). Interpretation SB fixation alone did not provide stability of the syndesmosis, and screw fixation became too rigid compared with the intact model. Using ST augmentation achieved dynamic stability similar to the intact model for syndesmotic injuries.
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