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Injury. 2012 Jun;43(6):838-42. doi: 10.1016/j.injury.2011.10.002. Epub 2011 Oct 27.

Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

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Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland.



Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).


Forty-nine patients with ankle diastasis, treated with Arthrex tightrope™, were reviewed retrospectively, using American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores and radiographic parameters for syndesmosis integrity. The operative technique was slightly modified by the senior author in 31 cases to avoid soft-tissue complications requiring removal of the implant. The aim of this study was to assess the rate of hardware removal after tightrope fixation and the effect of the author's modification to avoid soft-tissue complications.


The mean age of patients was 37.7 years. Eighteen were performed with standard technique whilst 31 with the modified technique. The mean radiological follow-up was 6 months. Final data were collected using a confidential questionnaire and FADI score at an average of 24 (12-38) months postoperatively. The average time to full weight bearing was 7.7 weeks and to return to normal activities was 11.2 weeks. Postoperative radiographic measurements demonstrated satisfactory reduction of syndesmosis. The Mean AOFAS score was 85.57 (95% confidence interval (CI) 77.96-93.18) and the mean FADI score was 81.20 (95% CI 73.86-88.53). There were three cases of hardware removal in the standard technique group as compared to none in the group with the modified technique.


Arthrex Tightrope™ provides an effective method of syndesmosis stabilisation, which obviates the need for routine removal of implant and facilitates dynamic stabilisation. The results of this study are satisfactory and comparable to previously reported studies. We emphasise that surgeons must be aware of the potential risk of soft-tissue complications and recommend our modified technique. Further long-term prospective studies should be carried out to resolve this issue.

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