Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 6, pp 1866–1872 | Cite as

Novel anatomical reconstruction of distal tibiofibular ligaments restores syndesmotic biomechanics

  • Jian CheEmail author
  • Chunbao Li
  • Zhipeng Gao
  • Wei Qi
  • Binping Ji
  • Yujie LiuEmail author
  • Ming Han Lincoln Liow



To date, there is a paucity of literature on syndesmotic reconstruction techniques that restore both anatomic stability and physiologic syndesmotic biomechanics. In this cadaveric study, (1) a novel syndesmotic reconstruction surgical technique using autogenous peroneus brevis tendon was described and (2) the biomechanical properties of the reconstruction was investigated.


Ten fresh-frozen lower extremities were used in this study. Reconstruction of the anterior and posterior, as well as the interosseous tibiofibular ligaments was performed with a halved peroneus brevis tendon. Biomechanics were assessed using foot external rotation torque and ankle dorsiflexion axial loading tests, which were performed in (a) intact, (b) cut, (c) anatomically reconstructed syndesmotic ligaments, and (d) 3.5 mm tricortical syndesmotic screw fixation. Medial–lateral and anterior–posterior displacements of the distal fibula were recorded during foot external rotation and fibular axial displacement was recorded during ankle axial loading.


The fibula was displaced posteriorly and proximally with respect to the tibia in all specimens during external rotation and axial loading tests, respectively. Significant differences (p < 0.05) were found in distal fibular displacements between anatomically reconstructed ligaments and screw fixation. Tricortical syndesmotic screw fixation resulted in 59% of posterior fibular displacement when compared to intact ligaments. No significant differences (n.s.) in distal fibular displacement were demonstrated between intact ligaments and anatomically reconstructed ligaments.


Anatomical reconstruction of the distal tibiofibular ligaments with the peroneus brevis tendon provides stability and recreates the biomechanical properties of an intact syndesmosis. This new surgical technique may be a viable alternative for the treatment of syndesmotic injuries.

Level of evidence



Anatomical reconstruction Surgical technique Distal tibiofibular ligaments Syndesmosis Biomechanical cadaveric study 



We acknowledged Institute of Applied Mechanics and Biomedical Engineering of Taiyuan University of Technology for their assistance in biomechanical study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


No funding was received for the writing of this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  1. 1.Department of OrthopedicsChinese PLA General HospitalBeijingChina
  2. 2.Department of OrthopedicsShanxi Huajin Orthopedic HospitalTaiyuanChina
  3. 3.Institute of Applied Mechanics and Biomedical EngineeringTaiyuan University of TechnologyTaiyuanChina
  4. 4.Department of Orthopedic SurgerySingapore General HospitalSingaporeSingapore

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