CHAPTER 9 TECHNIQUE , OF SYI \ DESMOTIC REPAIR : Investigating the Innovative Tightrope ' * in Treatment of Syndesmotic Injuries

Fractures of the adult anlde with disruption of the tibiofibular syndesmosis call for sufficient stabilization of the ankle mortise to ensure proper healing of the syndesmotic ligaments. Several internal fixation techniques for stabilization of the syndesmosis have been employed in the past, including 3.5 mm, 4.5 mm, and 5.0 mm metallic and bioabsorbable screws, 1.5 mm and 1.5 mm Kirschner wire fixation, and staple fixation. As technology advances and we increase our knowledge of the factors involved in the repair of syndesmotic injuries, an innovative syndesmotic repair device has recently been introduced. The TightRope*' (#AR-S920DS, AR-8921DS, Arthex, Naples, FL) is well suited for syndesmotic injuries of the ankle, because it opposes diastasis while allowing for favorable micromotion. The TightRope'offers a novel solution to many of the dilemmas encountered with traditional methods of syndesmotic repair. The device is constructed as to not require removal, it is resilient allowing ample ligament healing, and it is less invasive than traditionai syndesmotic screw insertion. The TightRope"' displays promise in the field of foot and ankle surgery. With this in mind, we critically look at this emerging tool and introduce the technique of insertion.