Continuous Loop Double Cortical Button Technique for Distal Tibiofibular Syndesmosis Stabilization: A Technical Note and Case Series

Injury to the distal tibiofibular syndesmosis is common and failure to correct instability may lead to inferior outcomes. Recently, suture-button devices have garnered increasing attention for dynamic syndesmotic fixation. However, current constructs and techniques have been consistently associated with complications such as lateral knot irritation and wound breakdown. In addition, knot slippage, loosening, and osteolysis have been described leading to recurrent syndesmotic diastasis. To address these shortcomings, a continuous loop double cortical button technique has been developed for dynamic syndesmotic stabilization. The continuous loop double cortical button technique has been utilized for coracoclavicular ligament stabilization for both acromioclavicular joint dislocation and distal clavicle fractures with excellent clinical outcomes. This procedure has been adapted for fixation of the distal tibiofibular syndesmosis. The technique utilizes 2 cortical buttons linked by a continuous loop of ultra-high molecular weight polyethylene suture for dynamic knotless syndesmotic fixation. The continuous loop double cortical button technique was performed on 4 consecutive cases of distal tibiofibular syndesmosis diastasis. Accurate, stable fixation was achieved in all cases without loosening or diastasis. At the final follow-up, no evidence of button-related osteolysis or migration was observed. One patient with prominent lateral hardware developed a wound infection requiring reo...

Source: Techniques in Foot and Ankle Surgery - May 19, 2020 Category: Orthopaedics Tags: Techniques Source Type: research