Ankle syndesmotic injuries: short-term radiological outcomes and complications following tightrope fixation

Abstract

Introduction: Ankle syndesmotic injuries are complex and require accurate reduction and stabilisation to restore normal ankle biomechanics. While traditional screw fixation is widely used, it carries risks such as screw loosening, breakage, and the need for secondary removal. The suture-button Tightrope system offers dynamic stabilisation and facilitates earlier mobilisation. This study aimed to evaluate radiographic stability and complications associated with the ankle Tightrope technique for ankle syndesmotic injuries at our institution.
Methods: We retrospectively reviewed 83 patients (mean age, 41.3 years) who underwent ankle Tightrope fixation for syndesmotic disruption between 2013 and 2023. Demographic data, injury characteristics, procedural details, radiographic parameters, and complications were systematically analysed.
Results: Tightrope fixation demonstrated a statistically significant improvement in syndesmotic parameters (MCS, TFO and TFCS), maintained throughout follow-up. Most patients achieved early weight-bearing within 6 weeks with a prolonged median follow-up of 20.4 weeks. The overall complication rate was 13.2%, with very low incidences of infection, device migration, button malposition, and syndesmotic diastasis. There were no cases of aseptic osteolysis, peri-implant fracture, or revision fixation.
Conclusions: Tightrope fixation provides a reliable, safe, and minimally invasive alternative to screw fixation for syndesmotic injuries, maintaining anatomical reduction with low complication rates. Its use facilitates early weight-bearing and accelerated rehabilitation, providing a reproducible and effective strategy for both isolated and fracture-associated syndesmotic disruptions.