High Ankle Sprains: Syndesmosis Repair Using Suture Implant Animation

High Ankle Sprains: Syndesmosis Repair Using Suture Implant Animation

The goal of this surgery is to bring the ends of the tibia and fibula back together after a high ankle sprain. The surgeon makes an incision on the outside of the ankle and a large clamp is used to keep the 2 bones in place. We'll remove the clamp for the purpose of this demonstration.

In this case, two separate suture implants will be used, so using this small plate helps to put even pressure across the bone. In this animation, the bones have been cut so we can see the area between them where the repair will take place. Next, two long pins are drilled through the holes in the plate through both ankle bones. A larger hole is drilled over each pin to make room for the suture implants.

In the past, the standard procedure was to use 2 long rigid metal screws in these same two locations to hold the bones together. This would require a second surgery to remove the screws to prevent long-term ankle stiffness. Now there are suture implants so that a second surgery isn't needed.

The suture implant is inserted all the way through the bones. A little thumb switch on the handle is flipped, releasing the metal button to make sure it sits flat against the shin bone and doesn't go back through the hole. The inserter is removed, and the second metal button is pushed down against the plate on the outside of the fibula.

The surgeon will slowly pull on the 2 white sutures to tighten the button, bringing the 2 bones back together. The same thing is done with the 2nd suture implant stabilizing that high ankle joint. The surgeon can retighten these back and forth until it is just right, all the extra suture is cut, and the repair is finished.