Arthroscopic-Assisted Adjustable Progressive Compression Fixation for Distal Tibiofibular Syndesmosis Injury

The distal tibiofibular syndesmosis injuries are a common type of ankle injury. Traditional rigid screw fixation presents issues such as restricting physiological micromotion and requiring a second surgery for removal. The existing elastic fixation techniques have limitations, including insufficient fixation strength and nonadjustable tension. This technical note describes an arthroscopic-assisted adjustable progressive compression fixation technique. By rotating the fibular-side EndoButton, the 4-strand high-tensile sutures synchronously twist and shorten, achieving continuous and controllable transverse compression of the distal tibiofibular syndesmosis. This technique combines the strength of rigid fixation with the physiological compliance of elastic fixation. Intraoperatively, tension can be adjusted in real-time based on tactile feedback, direct arthroscopic visualization, and fluoroscopic imaging, achieving an optimal balance between stability and micromotion. This technique provides a reliable fixation option for distal tibiofibular syndesmosis injuries.