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

APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 2: Indications for Surgical Treatment, Arthroscopic or Open Debridement, and Reconstruction Techniques of Suture Button and Screw Fixation

“…However, sagittal stability is lower with the single suture button. 23 Clanton et al 5 reported that 2 divergent suture buttons were beneficial for 2 reasons: First, if 1 of the devices loosened or failed, there would still be a backup device for stability; and second, if 2 devices were placed in a divergent orientation and were cinched down in an orderly, alternating fashion, this would allow the fibula to settle properly within the incisura, potentially aiding in the prevention of malreduction. No significant differences were observed in the American Orthopedic Foot & Ankle Society score.…”

“… 9 Previous studies concluded that 1 or 2 suture buttons were not able to restore stability in both the coronal and the sagittal planes compared with the uninjured syndesmosis. 5 , 9 , 23 , 25 Goetz et al 9 reported applying syndesmosis compression via 133 N (30 lb) suture tension. Shoji et al 23 concluded that AITFL augmentation using a suture tape that was oriented in the same direction as the AITFL fibers functioned as a substitute for the injured AITFL.…”

“… 5 , 9 , 23 , 25 Goetz et al 9 reported applying syndesmosis compression via 133 N (30 lb) suture tension. Shoji et al 23 concluded that AITFL augmentation using a suture tape that was oriented in the same direction as the AITFL fibers functioned as a substitute for the injured AITFL. Suture button with suture tape augmentation deserves consideration as a clinical tool for syndesmosis injuries.…”

Anterior Syndesmotic Augmentation Technique Using Nonabsorbable Suture-Tape for Acute and Chronic Syndesmotic Instability

“…39 The use of nonabsorbable suture-tape augmentation avoids graft-associated morbidities and may promote natural ligamentous healing. 26,39 Shoji et al 42 performed a biomechanical study comparing the stability of suture-button fixation alone, suturetape alone, suture-button fixation augmented with suture-tape, and metal screw fixation. They found that suture-tape alone and suture-button fixation augmented with suture-tape best replicated normal physiologic motion of the syndesmosis.…”

“…They found that suture-tape alone and suture-button fixation augmented with suture-tape best replicated normal physiologic motion of the syndesmosis. 42 Harris et al 20 presented preliminary results of 14 patients treated for acute syndesmotic injury using the InternalBrace at the British Orthopaedic Foot & Ankle Society 2018 Annual meeting. Of the 11 athletes treated, all had a final AOFAS score of 100.…”