Complications of Suture Button Ankle Syndesmosis Stabilization with Modifications of Surgical Technique

Background: The TightRope^® is a relatively new device designed to stabilize ankle syndesmotic injuries. There are no studies evaluating the clinical effectiveness of this technique and few reports addressing complications and potential modifications to the surgical technique reported in this article. Materials and Methods: A retrospective review of 102 cases of traumatic ankle syndesmotic stabilization using the TightRope device is presented. Patients were followed up for a median of 85 days after surgery. Results: Eight patients subsequently had the TightRope removed. This was performed for four reasons: osteomyelitis surrounding the implant, painful aseptic osteolysis surrounding the implant, failed stabilization of the syndesmosis, and unexplained pain. Conclusions: On the basis of experience, the authors recommend meticulous attention during the surgical technique. To prevent skin irritation and stitch abscess formation leading to osteomyelitis, the FiberWire loop is best cut with a knife at least 1 cm beyond the knot, allowing the sharp end of the FiberWire to lay flat adjacent to the fibula. Painful aseptic osteolytic reaction to the TightRope necessitates removal. To prevent rediastasis, a small medial incision is recommended for endobutton positioning directly abutting the tibial cortex without soft tissue interposition. Inserting the TightRope through a fibula plate prevents lateral button pull-through and rediastasis.

Level of Evidence: IV, Retrospective Case Series