“…The widely used screw fixation has been reported to have several drawbacks: the prolonged immobilization and related complications, late syndesmotic widening after screw removal, screw loosening, screw breakage, and the need for a second operation to remove the screw [21,22]. The more recent development is the Endobutton fixation and its use is rapidly increasing; potentially, this technique has the following advantages: allows physiologic micromotion at the syndesmosis and thus an earlier return to weightbearing was possible, lessens the risk of hardware pain and the implant removal will not be necessary, without the risk of screw breakage and subsequent recurrent syndesmotic diastasis [15,[23][24][25]. However, this method still has some defects such as the suture loop may relax under weightbearing conditions, local irritation, osteolysis of the bone and subsidence of the device into the bone (as was occasionally observed), and its relatively high cost and complexity [17,26].…”