International Orthopaedics

, Volume 43, Issue 3, pp 705–711 | Cite as

Strength of suture-button fixation versus ligament reconstruction in syndesmotic injury: a biomechanical study

  • Hong-Yun Li
  • Ru-Shou Zhou
  • Zi-Ying Wu
  • Yutong Zhao
  • Shi-Yi Chen
  • Ying-Hui HuaEmail author
Original Paper



To compare the biomechanical characteristics of suture-button fixation versus ligament reconstruction using semitendinosus tendon autograft in treatment of syndesmotic injury in cadaver biomechanical study.


Eight matched pairs of human cadaveric lower-extremities were measured intact, then following simulated syndesmosis injury by cutting the anterior tibiofibular ligament (AITFL), the distal 15 cm of the interosseous membrane (IO), and the deltoid ligament. Thereafter, the syndesmotic injury was treated by suture-button fixation or ligament reconstruction. The semitendinosus tendon was harvested as a graft. Biomechanical testing was performed after the surgical fixation. The foot underwent rotation from neutral position to an external rotation at a rate of 5°/s to 12.5 Nm. The three-dimensional syndesmotic diastasis readings, final rotation torque, and rotational angle were recorded.


No difference was found in fibular displacements between two groups. Moreover, no significant difference was found in final rotation torque (11.95 ± 1.03 VS 11.66 ± 1.18 Nm, P = 0.62) and rotation angle (43.61° ± 14.77° VS 40.93° ± 10.94°, P = 0.56) in the suture-button group and ligament reconstruction group.


The stability of the suture-button fixation was equivalent to ligament reconstruction using semitendinosus tendon autograft in treatment of syndesmotic injury as determined with biomechanical testing. However, this study does not prove that one is advantageous over the other.


Syndesmosis Instability Suture button Ligament reconstruction Biomechanics 



This work was supported by a grant awarded to Ying-Hui Hua from the National Natural Science Foundation of China (NSFC81572209).

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Hong-Yun Li
    • 1
  • Ru-Shou Zhou
    • 2
  • Zi-Ying Wu
    • 1
  • Yutong Zhao
    • 3
  • Shi-Yi Chen
    • 1
  • Ying-Hui Hua
    • 1
    Email author
  1. 1.Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan HospitalFudan UniversityShanghaiChina
  2. 2.Kunming Municipal Hospital of Traditional Chinese MedicineKunmingChina
  3. 3.Dunn SchoolLos OlivosUSA

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