High Ankle Sprains: Syndesmosis Repair Using a Suture Implant

High Ankle Sprains: Syndesmosis Repair Using a Suture Implant

In this cadaveric surgical demonstration, we will go through the steps of a surgeon performing a stabilization of a high ankle sprain with a suture-based implant rather than the use of rigid metal screws. This has allowed for quicker mobility and less chance for a second surgery.

The surgeon is working on a left ankle and is making a small incision over the fibula on the outside of the ankle. To be sure the implant is placed in the middle of the bone, the surgeon checks for the front and back edges of the fibula. The first step is to drill a hole into the fibula and then across and all the way through the tibia or shinbone. The surgeon does this with the help of x-ray to be sure they are at the correct angle and going through the entire bone.

The surgeon now takes the suture implant that has metal buttons on each side and places it through the drill hole until the metal button on the tip exits the tibia. The implant pushes up against the skin but does not go completely through. The inserter is angled in such a way that the metal button will face the correct direction. The surgeon will use x-ray again to verify that the implant is being placed correctly.

The safety tab is removed from the inserter handle, and the small black button is pressed to release the metal button off the tip of the inserter, so it lays flat against the bone. The surgeon will use x-ray again to verify that the implant is being placed correctly. Now, there is a metal button on the inside part of the ankle, suture going across the ankle and through the bone tunnel, and a second metal button on the outside of the ankle.

The suture in between is now tightened so the metal buttons sit tight and flat on the bones and the suture helps hold the ankle joint back into normal position. The surgeon will check a final x-ray to be sure the buttons are in the correct location, and the ankle joint is stabilized. Some surgeons will add a second implant based on how bad the injury is. The soft tissue and skin will be closed up, a splint gets put on, and the patient will begin their recovery.