Arthroscopic Stabilization for Chronic Latent Syndesmotic Instability

Subtle syndesmotic instability not evident on radiography can result in chronic ankle pain. The diagnosis is uncommon, and arthroscopic evaluation remains the gold standard for diagnosis. Definitive surgical management can be performed at the time of diagnosis. Patients with 2 to 4 mm of diastasis of the syndesmosis or translation can be treated with debridement alone, and patients with 4 mm or more of diastasis or translation can be treated with arthroscopic debridement and reduction followed by percutaneous stabilization. Percutaneous stabilization is accomplished by a TightRope technique, which involves passing 1 or 2 suture buttons through all 4 cortices of the distal tibia and fibula. This technique is used in lieu of the traditional syndesmotic screw, which requires a subsequent operation for removal.