title: Outcomes of suture button repair of the distal tibiofibular syndesmosis.
abstract: BACKGROUND
  Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced.
  
  
  METHODS
  We reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The primary outcomes measure was the AOFAS ankle hindfoot score. Secondary outcomes measures included a calibrated measurement of the tibiofibular clear space and tibiofibular overlap.
  
  
  RESULTS
  The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament, one mild, one moderate, and one who had a nearly complete syndesmotic fusion.
  
  
  CONCLUSIONS
  The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur.
authors.affiliation: Newton Wellesley Hospital, Newton, MA 02462, USA. hd3@drdegroot.com
authors.forename: Henry
authors.initials: H
authors.lastname: Degroot
authors.forename: Ali A
authors.initials: AA
authors.lastname: Al-Omari
authors.forename: Sherif Ahmed
authors.initials: SA
authors.lastname: El Ghazaly
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D009999:Ossification, Heterotopic; D016896:Treatment Outcome; D055815:Young Adult