Anterior and Posterior Syndesmotic Augmentation Using Nonabsorbable Suture Tape for Acute Syndesmotic Instability: A Technical Note

Abstract

Background: Syndesmotic instability presents a significant challenge in orthopedic surgery, with no universally accepted treatment approach. Traditional methods, such as trans-syndesmotic screw fixation, remain widely used but are associated with complications, including malreduction, hardware-related issues, and restricted physiological motion. Recent advancements in flexible dynamic fixation, particularly suture tape augmentation, offer promising alternatives by preserving native biomechanics and enabling early rehabilitation. Methods: This technical note details an anterior-to-posterior syndesmotic augmentation technique using suture tape to address unstable syndesmotic injuries involving both the anterior inferior tibiofibular ligament and posterior inferior tibiofibular ligament. The proposed technique aims to restore stability, reduce complications, and improve functional outcomes. Results: The technique eliminates the need for hardware removal, supports early weight-bearing, and minimizes postoperative limitations. Conclusions: Anterior-to-posterior syndesmotic augmentation with suture tape represents a viable alternative for syndesmotic instability. Further clinical and biomechanical studies are warranted to validate its long-term efficacy and applicability across diverse patient populations.