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Abstract

Background:

Industry funding can increase the likelihood of positive outcomes. This study sought to investigate whether industry funding or conflicts of interest (COI) for studies investigating suture button fixation devices for ankle syndesmosis injuries influenced outcomes.

Methods:

PubMed, Scopus, and Embase were queried for studies investigating suture button fixation devices for the ankle. Included studies investigated suture button fixation devices for the ankle and reported funding or COI. Excluded studies were systematic reviews, meta-analyses, and case reports. Outcomes were categorized into “positive” if the null hypothesis was rejected or outcomes favored the implant, “neutral” if the null hypothesis was confirmed, or “negative” if the result was unfavorable toward the implant. Studies were grouped into industry-funded, nonfunded, and “other” funding, including specialty societies, National Institutes of Health (NIH), and grants. Studies were also grouped by the presence or absence of COI. Chi-squared test was used to test for significance defined as P <.05.

Results:

A total of 112 studies were included for analysis. Of these, 19 (17%) were industry-funded, 21 (19%) had other funding sources, and 72 (64%) were nonfunded. The proportion of studies with positive outcomes was 48% in industry-funded studies, 63% in studies with other funding sources, and 65% in nonfunded studies. There was no significant association between funding source and outcome (P = .063). A COI was present in 42 studies (37.5%), and no COI was present in 70 studies (62.5%). The proportion of positive studies in those with a COI was 52%, whereas in studies without a COI, it was 67%. Positive studies were significantly associated with studies without COI (P = .003).

Conclusion:

Industry funding and COI was not found to be associated with an increased likelihood of positive outcome reporting in studies on suture-button fixation for ankle syndesmostic injuries; we found in this review that positive outcomes are more likely in studies without COI.

Keywords

ankle syndesmosis suture-button fixation Tightrope industry bias funding bias conflict of interest

Introduction

Ankle syndesmotic injuries, which disrupt the ligamentous structures stabilizing the distal tibiofibular joint, pose a significant challenge in orthopaedic practice due to their potential for long-term complications, including joint instability and posttraumatic arthritis.¹⁹ Among the various treatment modalities available, suture button fixation has gained prominence as an alternative to traditional methods. The purported advantages of suture button systems include dynamic stabilization, reduced risk of implant failure, and earlier return to function.¹²⁵ These features have positioned suture buttons as a popular choice, particularly in complex cases, and have sparked substantial interest in their clinical outcomes.^80,126

With the growing adoption of suture button fixation, industry funding has increasingly supported research in this area, as device manufacturers attempt to obtain market share of a developing space. Although industry funding is critical for driving innovation and enabling large-scale clinical trials, it raises concerns about potential biases in the design, conduct, and reporting of studies. Evidence from other areas of orthopaedic surgery suggests that industry-funded research is more likely to report favorable outcomes, potentially skewing the clinical perception of implant performance.^3,35,66,76 Furthermore, industry funding can cause biases even within high-level evidence studies, like randomized controlled trials (RCTs). Industry funding has been shown to affect methodology in RCTs and is associated with discrepancies between primary outcomes of the RCT registration and its publication.^31,62,67 Given the commercial and clinical implications of suture button fixation devices, it is essential to critically evaluate whether funding sources influence reported outcomes and complication rates.

This study seeks to systematically analyze the impact of industry funding on the findings of studies investigating suture button fixation in ankle syndesmotic injuries. By examining trends in funding patterns and reported outcomes, this study aims to assess the extent of potential bias in the literature and provide clinicians with a clearer understanding of the evidence base supporting suture button systems. We hypothesized that studies with industry funding would be more likely to report positive outcomes.

Methods

Literature Screening

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and Web of Science were queried for studies investigating suture-button fixation devices for the ankle syndesmosis. The search strategy was as follows: (“ankle” OR “syndesmo*” OR “tibiofibular”) AND (“suture button” OR “button” OR “tightrope”). Included studies were those that were investigating suture-button fixation for ankle syndesmosis, reported on the presence or absence of funding sources or conflicts of interest (COI), and were published in English in peer-reviewed journals. Exclusion criteria were: systematic reviews and meta-analyses, case reports, abstracts, and studies with no full text. Any study that failed to mention funding information or conflicts of interest was excluded.

This study was not registered with PROSPERO in advance. A review protocol is available upon request.

Screening and Grouping

Studies were compiled in Covidence (Melbourne, Australia). Two authors (C.L.F. and E.H.L) independently screened studies by title and abstract before 2 additional authors (A.A.J. and S.C.T) screened studies by full text. Disputes were resolved by a third author (A.K.S.). Two authors (A.A.J. and S.C.T) categorized studies by funding. These groups included “nonfunded,” if the study explicitly indicated that no funding was used; “industry-funded,” which included studies using funding, grants, and donated materials from industry-affiliated companies; and “other funding,” which included studies using grants or support from specialty societies, government, and institutional. Studies were also grouped by the presence or absence of COI.

Two authors (C.L.F. and E.H.L) independently categorized studies into groups based on outcome. Studies were deemed to have “positive” outcomes if the results significantly favored the implant by, for example, demonstrating better clinical or patient-reported outcomes, performing better in biomechanical studies, or showing cost-effectiveness compared with alternative options. Studies were deemed “neutral” if the null hypothesis failed to be rejected or if there were multiple endpoints and some favored while others disfavored the implant, or the endpoint result could be deemed as neither favorable nor unfavorable for the implant. Studies with “negative” outcomes were those whose findings did not favor the implant, if the study recommended against its use, if it performed worse than alternatives in biomechanical studies, or it was found to be cost-ineffective compared with alternative management options.

Quality Assessment

A quality assessment tool was used to evaluate the quality of each study included. For clinical studies, the Methodological Index for Non-Randomized Studies (MINORS) was used.¹⁰⁴ For comparative clinical studies, the maximum MINORS score is 24, and for noncomparative clinical studies, the maximum MINORS score is 16. For cadaver studies, the Quality Appraisal for Cadaveric Studies (QUACS) scale was used.¹¹⁹ The maximum QUACS score is 13.

Data Analysis

All data was recorded descriptively. RStudio (Boston, MA) was used for all statistical analyses. Fisher exact test was used to test for association between outcome type and funding category. Statistical significance was set at P < .05.

Results

Screening

Initial search results yielded 1246 studies, from which 618 duplicates were removed by Covidence. During the first phase of the screen, 486 studies were removed after being found to not fit inclusion criteria based on title and abstract. These included systematic reviews, case reports, use of suture-button devices for other anatomical regions, etc. In the full-text screen, 26 studies were removed. The full text could not be located for 3, funding and COI were not reported in 1, 13 studies were not in English, 4 were duplicate studies, and 5 were of the wrong study design. A total of 112 studies were included for analysis (Figure 1).^{1,2,4,5,8,9,11
-18,20
-22,24
-26,28
-30,32
-34,36
-59,61,63
-65,68
-75,77
-100,102,103,105
-118,120
-124,126,128
-132}

Figure 1.

PRISMA diagram demonstrating search results.

Study Characteristics

The included studies were published between 2005 and 2024. A majority (54%) of these studies were published in or after 2020. Of the 112 studies, 8 (7.1%) were of level of evidence (LOE) I, 10 (8.9%) were of LOE II, 18 (16.1%) were of LOE III, 51 (45.5%) were of LOE IV, and 25 (22.3%) were of LOE V. Of the 73 clinical studies that underwent quality assessment using MINORS, 38 (52.1%) were comparative and 35 (47.9%) were noncomparative. The average MINORS score for comparative studies was 17.8 ± 3.8 and the average MINORS score for noncomparative studies was 9.8 ± 2.4. The average QUACS score for the 34 cadaveric studies was 12.9 ± 0.9. Five studies could not be assessed using MINORS or QUACS as they were cost analysis, cost model, and computer model studies.

Outcomes and Funding

Industry funding was used in 19 studies (17%),^{13,16,25,30,32,38,57,64,75,82,84,85,95,97,99,100,109,122,123} other sources of funding were used in 21 studies (19%),^{5,9,11,26,42,44,46
-48,54,58,59,68,71,72,106,108,114,118,131,132} and no funding was used in 72 studies (64%).^{1,2,4,9,12,14,15,17,18,20
-22,24,26,28,29,33,34,36,37,39
-41,43,45,49
-51,53,55,56,61,63,65,69,70,73,74,77
-86,81,86
-94,96,98,102,103,105,108,111
-113,115
-117,120,121,124,126,128
-130} Of all the 112 studies included, 69 (61.6%) demonstrated positive outcomes, 26 (23.2%) demonstrated neutral outcomes, and 17 (15.2%) demonstrated negative outcomes. When broken down by funding type, of the industry-funded studies, 10 (52%) were positive, 7 (37%) were negative, and 2 (11%) were neutral. Studies with other sources of funding were positive in 12 studies (57%), neutral in 5 studies (24%), and negative in 4 studies (19%). For nonfunded studies, 47 (65%) had positive results, 18 (25%) had neutral results, and 7 (10%) had negative results. Outcomes reporting was not significantly associated with study funding type (P = .063) (Table 1).

Table 1.

χ² 3 × 3 contingency table of outcomes grading by funding type.

	Positive Outcome	Negative Outcome	Neutral Outcome
Industry funding	10	7	2
Nonfunded	47	7	18
Other funding	12	4	5
P value			.063

The presence of at least 1 COI was identified in 42 studies (37.5%)^{5,13,16,20,26,29,30,32,38,39,49,51,54,57,58,64,70,75,79
-86,88,94,95,97,99,100,105,107
-109,112,117,118,122,123,131} and no COI was present in 70 studies (62.5%).^{1,2,4,8,9,11,12,14,15,17,18,21,22,24,28,34,36,37,40
-48,50,52,53,55,56,59,61,63,65,68,69,71
-74,75,78,87,89
-93,96,98,102,103,106,110,111,113
-116,120,121,124,126,128
-132} Positive outcomes were seen in 22 studies (52%) with a COI vs in 47 studies (67%) without a COI. Negative outcomes were seen in 13 studies (31%) with a COI and in only 5 studies (7%) without COI. Outcome reporting was significantly associated with the presence or absence of COI (P = .003) (Table 2). Positive outcomes were more likely among studies without COI, and negative outcomes were more likely among studies with COI.

Table 2.

χ² 3 × 2 Contingency Table Comparing Study Outcomes by the Presence or Absence of COI.

	Positive Outcomes	Neutral Outcomes	Negative Outcomes
COI present	22	7	13
COI absent	47	18	5
P value			.003

Discussion

This study demonstrates that industry funding shows no association with outcomes and that the presence of COI has the opposite association of what would be expected, with these studies being more likely to report negative or neutral outcomes than studies without funding or COI. The majority of studies on suture button fixation received no funding, whereas less than a quarter were industry-funded. Outcomes that favored suture button fixation devices were found in more than half of the included studies.

The cost of bringing a new medical device to market is one of the driving forces behind industry bias in research. Rigid fixation using screws is the historical option for managing injuries to the ankle syndesmosis. Suture button fixation devices were introduced to the landscape more recently, with the first receiving Food and Drug Administration (FDA) approval in 2005.⁷ For the industry, developing new medical devices and gaining FDA approval can be a long and expensive process. Sertkaya et al¹⁰¹ conducted an economic analysis to identify how costly the FDA approval process can be. When accounting for failed studies and the cost of capital, the mean price for bringing a novel therapeutic complex device to market is more than $500 million. An expedited approval process known as the 510(k) premarket notification exists, which can be used for devices substantially equivalent to an existing device. Yang et al¹²⁷ found that for orthopaedic devices approved through the 510(k) premarket notification, as multiple suture-button devices received,^7,27 the average amount of time for industry to recoup investments was more than 2 years. Given the resources required to develop and bring new devices to market, it is understandable that industry companies would fund research to help demonstrate the efficacy and safety of their product.

Industry sponsorship in research does not only benefit the companies when leading to the publication of favorable findings, but it also helps fuel higher-impact studies. In orthopaedic research, industry-sponsored studies make up the majority of level I studies.²³ Further, industry funding is associated with higher numbers of patients involved in research and multicontinental recruitment locations.⁶⁰ Thus, industry funding is beneficial in supporting higher-powered studies with greater generalizability. However, this comes with the risk of industry bias, which has been well-established in orthopaedic research.^3,35,66 The findings of this study demonstrate that in research on dynamic suture-button fixation of the ankle syndesmosis, the presence of COI is instead associated with higher rates of neutral and negative outcomes. This may suggest an increased awareness of industry biases in orthopaedic research and an active effort to increase transparency among studies with these types of affiliations. Therefore, clinicians can potentially use the findings of research on these devices with less concern about this bias affecting their clinical decision making. In bolstering high-impact research, industry funding may also strengthen the literature on suture-button fixation.

The majority of research on suture-button fixation for the ankle demonstrated favorable results. These positive outcomes were not associated with funding sources. This is in contrast with research on shoulder arthroplasty and new technologies in hip and knee arthroplasty, for example, where industry funding is associated with favorable outcomes.^10,35 Importantly, funding bias is prevalent within orthopaedic literature more broadly. Dubin et al²³ found that conflicts of interest were significantly associated with positive outcomes in more than 1000 studies in the top 3 high-impact orthopaedic journals. To accurately assess for funding bias, transparency in the reporting of funding and conflicts of interest is required. Anz et al⁶ demonstrated that in clinical trials on biological treatments in orthopaedics, 49% of studies did not report study funding. Studies on suture-button fixation were excluded if they did not report on funding. Therefore, it was impossible to account for studies that may have lacked this transparency in this analysis. Hence, caution is always recommended when interpreting study results.

Strengths of this study include adherence to PRISMA guidelines, resulting in a comprehensive search strategy using multiple major literature databases. This study provides practical insights to both research and clinicians when evaluating the outcomes of suture button studies. This study is not without limitations. First, the sample sizes of the nonfunded and other funding groups were much smaller than the industry-funded group. This reduces the power to detect significant differences. Second, despite efforts to create a comprehensive search strategy, it is possible our search did not capture all studies that meet inclusion criteria. The studies included in this analysis were also quite heterogeneous. To provide an analysis generalizable to the entire ankle suture-button body of literature, we did not use inclusion or exclusion criteria that specified injury type, presence or absence of concomitant procedures, or endpoint measures. This study was also not able to stratify by amount of industry funding. For example, studies receiving payment from industry sources to carry out the study and studies that simply received donated devices were grouped together. We were also not able to account for how much money was contributed to each study, as this information is unavailable. Further, as a cross-sectional study, we are not able to identify causation, but only correlation. Future research into this topic could work to identify if industry funding in suture-button fixation research is associated with higher level of evidence research.

Conclusion

Funding type was not associated with outcomes but studies with at least 1 COI were significantly more likely to produce outcomes that were negative or neutral toward the suture-button construct for the ankle. The majority of the body of literature on this device demonstrates findings that are favorable toward suture-button devices. Clinicians using research to help inform their practice should always be concerned for the presence of biases within research.

Supplemental Material

sj-pdf-1-fao-10.1177_24730114251341305 – Supplemental material for Disclosed Industry Funding Does Not Increase Positive Outcomes in Studies on Suture Button Fixation for Ankle Syndesmotic Injuries: A Systematic Review

Supplemental material, sj-pdf-1-fao-10.1177_24730114251341305 for Disclosed Industry Funding Does Not Increase Positive Outcomes in Studies on Suture Button Fixation for Ankle Syndesmotic Injuries: A Systematic Review by Cailan L. Feingold, Eric H. Lin, Ajith K. Subhash, Samuel C. Tercyak, Aidan A. Jagasia, Eric W. Tan, Alexander B. Peterson and Joseph N. Liu in Foot & Ankle Orthopaedics

Footnotes

Ethical Approval

Ethical approval was not sought for the present study.

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eric W. Tan, MD, reports consulting or advisory fees from Stryker Orthopaedics. Joseph N. Liu, MD, reports speaking and lecture fees from Stryker Orthopaedics and travel reimbursement from Innocoll Biotherapeutics NA Inc. Disclosure forms for all authors are available online.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Cailan L. Feingold, BS,

Ajith K. Subhash, MD,

Joseph N. Liu, MD,

Data availability

Data are available on reasonable request from the corresponding author.

References

Alastuey-López

Seral

Pérez

. Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: screw vs. suture button. Comput Methods Programs Biomed. 2021;208:106272. doi:10.1016/j.cmpb.2021.106272

Altmeppen

Colcuc

Balser

, et al. A 10-year follow-up of ankle syndesmotic injuries: prospective comparison of knotless suture-button fixation and syndesmotic screw fixation. J Clin Med. 2022;11(9):2524. doi:10.3390/jcm11092524

Amiri

Kanesalingam

Cro

Casey

AT.

Does source of funding and conflict of interest influence the outcome and quality of spinal research?

Spine J. 2014;14(2):308-314. doi:10.1016/j.spinee.2013.10.047

Anand

Wei

Patel

Vedi

Allardice

Anand

BS.

Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series. Eur J Orthop Surg Traumatol. 2017;27(4):461-467. doi:10.1007/s00590-016-1882-8

Andersen

Frihagen

Hellund

Madsen

Figved

Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury. J Bone Joint Surg Am. 2018;100(1):2-12. doi:10.2106/JBJS.16.01011

Anz

Ahmad

Kozemchak

Rao

Warth

Harner

CD.

Funding sources are under-reported in randomised clinical trials of biological treatments in sports medicine: a systematic review. J ISAKOS. 2020;5(6):371-377.

Arthrex. 510K Arthrex TightRope Syndesmosis Devices. 2005. https://www.arthrex.com/de/weiterfuehrende-informationen/K043248/510k-arthrex-tightrope-syndesmosis-devices

Baker

Gerak

Muir

, et al. All-suture fixation of syndesmotic injuries: a case series. Eur J Orthop Surg Traumatol. 2024;34(3):1279-1286. doi:10.1007/s00590-023-03797-3

Baker

Muriuki

Straszewski

, et al. Comparison of a novel modified all-suture construct versus suspensory suture-button fixation in a syndesmotic injury model. J Orthop Trauma. 2023;37(3):e104-e110. doi:10.1097/BOT.0000000000002503

10.

Barakat

Ramamurti

Duensing

Browne

JA.

Financial conflicts of interest and industry funding are associated with conclusions favorable to new technologies: a review of published economic analyses in hip and knee arthroplasty. J Arthroplasty. 2024;39(9s1):S299-S305.e9. doi:10.1016/j.arth.2024.02.054

11.

Bazaluk

Chuzhak

Sulyma

, et al. Determining the tightrope tightening force for effective fixation of the tibiofibular syndesmosis during osteomeatal synthesis of fibula injuries. Appl Sci. 2022;12(10):4903. doi:10.3390/app12104903

12.

Bondi

Rossi

Pizzoli

Renzi Brivio

The use of TightRope fixation for ankle syndesmosis injuries: our experience. Musculoskelet Surg. 2016;100(3):217-222. doi:10.1007/s12306-016-0421-4

13.

Boyd

Doty

Kluemper

Kadakia

AR.

Anatomic risk to the neurovascular structures with a medially based all-inside syndesmosis suture button technique. J Foot Ankle Surg. 2020;59(1):95-99. doi:10.1053/j.jfas.2019.07.016

14.

Chan

LYT

Heng

HYC

Kon Kam King

. Investigating the radiological outcomes of syndesmosis injuries in ankle fracture patients after suture button fixation. J Foot Ankle Surg. 2022;61(2):350-354. doi:10.1053/j.jfas.2021.09.013

15.

Chen

Huang

Lee

Tsuang

YH.

Injury mechanism affects the stability of suture-button syndesmosis fixation. J Orthop Surg Res. 2020;15(1):599. doi:10.1186/s13018-020-02141-3

16.

Clanton

Whitlow

Williams

, et al. Biomechanical comparison of 3 current ankle syndesmosis repair techniques. Foot Ankle Int. 2017;38(2):200-207. doi:10.1177/1071100716666278

17.

Colcuc

Blank

Stein

, et al. Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):3156-3164. doi:10.1007/s00167-017-4820-3

18.

Colcuc

Wähnert

Raimann

, et al. The effect of stabilization procedures on sports discipline and performance level in non-elite athletes after acute syndesmotic injury: a prospective randomized trial. J Clin Med. 2022;11(15):4609. doi:10.3390/jcm11154609

19.

Cornu

Manon

Tribak

Putineanu

Traumatic injuries of the distal tibiofibular syndesmosis. Orthop Traumatol Surg Res. 2021;107(1s):102778. doi:10.1016/j.otsr.2020.102778

20.

Cottom

Hyer

Philbin

Berlet

GC.

Treatment of syndesmotic disruptions with the Arthrex Tightrope: a report of 25 cases. Foot Ankle Int. 2008;29(8):773-780. doi:10.3113/FAI.2008.0773

21.

Cottom

Hyer

Philbin

Berlet

GC.

Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and EndoButton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620-630. doi:10.1053/j.jfas.2009.07.013

22.

Degroot

Al-Omari

El Ghazaly

SA.

Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250-256. doi:10.3113/FAI.2011.0250

23.

Dubin

Hameed

Baksh

, et al. Impact of reporting bias, conflict of interest, and funding sources on quality of orthopaedic research. J Arthroplasty. 2024;39(5):1348-1352. doi:10.1016/j.arth.2023.11.017

24.

Duggan

Chong

Uglem

TP.

Center-center surgical technique with dynamic syndesmosis fixation: a cadaveric pilot study. J Foot Ankle Surg. 2024;63(1):92-96. doi:10.1053/j.jfas.2023.09.004

25.

Ebramzadeh

Knutsen

Sangiorgio

Brambila

Harris

TG.

Biomechanical comparison of syndesmotic injury fixation methods using a cadaveric model. Foot Ankle Int. 2013;34(12):1710-1717. doi:10.1177/1071100713503816

26.

Elghazy

Hagemeijer

Guss

, et al. Screw versus suture button in treatment of syndesmosis instability: comparison using weightbearing CT scan. Foot Ankle Surg. 2021;27(3):285-290. doi:10.1016/j.fas.2021.01.001

27.

FDA. 510(k) Premarket Notification. 2017. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?id=K173550

28.

Flanagan

Solomon

Michalski

, et al. Does a reduced secondary operation rate offset higher implant charges when utilizing suture button fixation for syndesmotic injuries? J Orthop Trauma. 2023;37(2):77-82. doi:10.1097/BOT.0000000000002476

29.

Förschner

Beitzel

Imhoff

, et al. Five-year outcomes after treatment for acute instability of the tibiofibular syndesmosis using a suture-button fixation system. Orthop J Sports Med. 2017;5(4):2325967117702854. doi:10.1177/2325967117702854

30.

Forsythe

Freedman

Stover

Patwardhan

AG.

Comparison of a novel FiberWire-button construct versus metallic screw fixation in a syndesmotic injury model. Foot Ankle Int. 2008;29(1):49-54. doi:10.3113/FAI.2008.0049

31.

Gaudino

Hameed

Rahouma

, et al. Characteristics of contemporary randomized clinical trials and their association with the trial funding source in invasive cardiovascular interventions. JAMA Intern Med. 2020;180(7):993-1001. doi:10.1001/jamainternmed.2020.1670

32.

Goetz

Davidson

Rudert

Szabo

Karam

Phisitkul

Biomechanical comparison of syndesmotic repair techniques during external rotation stress. Foot Ankle Int. 2018;39(11):1345-1354. doi:10.1177/1071100718786500

33.

Gräff

Alanazi

Alazzawi

, et al. Screw fixation for syndesmotic injury is stronger and provides more contact area of the joint surface than TightRope^®: a biomechanical study. Technol Health Care. 2020;28(5):533-539. doi:10.3233/THC-191638

34.

Güvercin

Abdioğlu

Dizdar

Yaylacı

Suture button fixation method used in the treatment of syndesmosis injury: a biomechanical analysis of the effect of the placement of the button on the distal tibiofibular joint in the mid-stance phase with finite elements method. Injury. 2022;53(7):2437-2445. doi:10.1016/j.injury.2022.05.037

35.

Haislup

Gupta

Fleisher

Murthi

Wright

MA.

Funding bias in shoulder arthroplasty research. J Shoulder Elbow Surg. 2024;33(8):e438-e442. doi:10.1016/j.jse.2024.03.016

36.

Hennings

Fuchs

Spiegl

, et al. “Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome. Int Orthop. 2022;46(11):2649-2657. doi:10.1007/s00264-022-05550-7

37.

Hennings

Souleiman

Heilemann

, et al. Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements. BMC Musculoskelet Disord. 2021;22(1):970. doi:10.1186/s12891-021-04834-0

38.

Honeycutt

Riehl

JT.

Effect of a dynamic fixation construct on syndesmosis reduction: a cadaveric study. J Orthop Trauma. 2019;33(9):460-464. doi:10.1097/BOT.0000000000001506

39.

Hong

Harrison

Clough

Calder

Association of periprosthetic fibula fracture with knotless suture button (TightRope) fixation for ankle syndesmosis in elite athletes. Orthop J Sports Med. 2023;11(11):23259671231206185. doi:10.1177/23259671231206185

40.

Ibnu Samsudin

Yap

MQW

Wei Luong

Kwek

EBK.

Slippage of tightrope button in syndesmotic fixation of Weber C malleolar fractures: a case series. Foot Ankle Int. 2018;39(5):613-617. doi:10.1177/1071100717749533

41.

İğrek

Ulusoy

İ.

What is the best treatment for syndesmosis fixation? Suture-button or syndesmotic screw? Bilateral CT-based early postoperative analysis. Foot Ankle Surg. 2023;29(2):128-135. doi:10.1016/j.fas.2022.12.003

42.

Imam

Holton

Hassan

Matthana

A novel suture button construct for acute ankle syndesmotic injuries; a prospective clinical and radiological analysis. Arch Bone Jt Surg. 2018;6(3):189-195.

43.

Imam

Matthana

Kim

Nabil

A 24-month follow-up of a custom-made suture-button assembly for syndesmotic injuries of the ankle. J Foot Ankle Surg. 2017;56(4):744-747. doi:10.1053/j.jfas.2017.02.010

44.

Jia

Cheng

Zhong

, et al. Titanium cable isotonic annular fixation system for the treatment of distal tibiofibular syndesmosis injury. Am J Transl Res. 2019;11(8):4967-4975.

45.

Jlidi

Bouaicha

Sbaihi

, et al. Comparative study for surgical treatment of acute distal tibiofibular syndesmotic lesions using the modified suture-button fixation versus static syndesmotic screw fixation. Foot Ankle Spec. 2024:19386400241256440. doi:10.1177/19386400241256440

46.

Kim

Park

CH.

Hybrid fixation for Danis-Weber type C fractures with syndesmosis injury. Foot Ankle Int. 2021;42(2):137-144. doi:10.1177/1071100720964799

47.

Kim

Kwon

Day

Seilern und Aspang

Shim

Cho

The impact of suture button removal in syndesmosis fixation. J Clin Med. 2021;10(16):3726. doi:10.3390/jcm10163726

48.

Kim

Gwak

Lee

Choo

Kim

DY.

A comparison of screw fixation and suture-button fixation in a syndesmosis injury in an ankle fracture. J Foot Ankle Surg. 2016;55(5):985-990. doi:10.1053/j.jfas.2016.05.002

49.

Kim

Shin

HS.

Suture anchor augmentation for acute unstable isolated ankle syndesmosis disruption in athletes. Foot Ankle Int. 2021;42(9):1130-1137. doi:10.1177/10711007211015188

50.

Kimura

Yamaguchi

Ono

, et al. Changes in the syndesmotic reduction after syndesmotic suture-button fixation for ankle malleolar fractures: 1-year longitudinal evaluations using computed tomography. Foot Ankle Int. 2021;42(10):1270-1276. doi:10.1177/10711007211008518

51.

Klitzman

Zhao

Zhang

Strohmeyer

Vora

Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69-75. doi:10.3113/FAI.2010.0069

52.

Kocadal

Yucel

Pepe

Aksahin

Aktekin

CN.

Evaluation of reduction accuracy of suture-button and screw fixation techniques for syndesmotic injuries. Foot Ankle Int. 2016;37(12):1317-1325. doi:10.1177/1071100716661221

53.

Kong

Viswanathan

Razii

Hazarika

Surgical outcomes of syndesmotic fixation of ankle fractures using syndesmotic screws versus suture button devices. Cureus. 2024;16(7):e65051. doi:10.7759/cureus.65051

54.

Kortekangas

Savola

Flinkkilä

, et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury. 2015;46(6):1119-1126. doi:10.1016/j.injury.2015.02.004

55.

Kromka

Chambers

Popchak

Irrgang

Hogan

MV.

In a small retrospective cohort of patients with syndesmotic injury, only athletes benefited from placement of a suture button device: a pilot study. J ISAKOS. 2019;4(1):21-25. doi:10.1136/jisakos-2018-000234

56.

Kurtoglu

Kochai

Inanmaz

, et al. A comparison of double single suture-button fixation, suture-button fixation, and screw fixation for ankle syndesmosis injury: a retrospective cohort study. Medicine (Baltimore). 2021;100(13):e25328. doi:10.1097/MD.0000000000025328

57.

Laflamme

Belzile

Bédard

van den Bekerom

Glazebrook

Pelet

A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015;29(5):216-223. doi:10.1097/BOT.0000000000000245

58.

LaMothe

Baxter

Gilbert

Murphy

Karnovsky

Drakos

MC.

Effect of complete syndesmotic disruption and deltoid injuries and different reduction methods on ankle joint contact mechanics. Foot Ankle Int. 2017;38(6):694-700. doi:10.1177/1071100717696360

59.

LaMothe

Baxter

Murphy

Gilbert

DeSandis

Drakos

MC.

Three-dimensional analysis of fibular motion after fixation of syndesmotic injuries with a screw or suture-button construct. Foot Ankle Int. 2016;37(12):1350-1356. doi:10.1177/1071100716666865

60.

Lan

Paranjpe

Saeed

Perez

MV.

Characteristics of contemporary atrial fibrillation clinical trials and their association with industry sponsorship. Heart Rhythm. 2024;21(9):1517-1523. doi:10.1016/j.hrthm.2024.03.001

61.

Latham

Goodwin

Stirling

Budgen

Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report. BMJ Open Sport Exerc Med. 2017;3(1):e000175. doi:10.1136/bmjsem-2016-000175

62.

Lathyris

Patsopoulos

Salanti

Ioannidis

JP.

Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest. 2010;40(2):172-182. doi:10.1111/j.1365-2362.2009.02240.x

63.

Lehtola

Leskelä

Flinkkilä

, et al. Suture button versus syndesmosis screw fixation in pronation-external rotation ankle fractures: a minimum 6-year follow-up of a randomised controlled trial. Injury. 2021;52(10):3143-3149. doi:10.1016/j.injury.2021.06.025

64.

Lehtonen

Pinto

Patel

Dahlgren

Abyar

Shah

Syndesmotic fixation with suture button: neurovascular structures at risk: a cadaver study. Foot Ankle Spec. 2020;13(1):12-17. doi:10.1177/1938640019826699

65.

Lenz

Urbanschitz

Shepherd

DW.

Dynamic syndesmotic stabilisation and reinforcement of the antero-inferior tibiofibular ligament with internal brace. Foot (Edinb). 2023;56:102026. doi:10.1016/j.foot.2023.102026

66.

Leopold

Warme

Fritz Braunlich

Shott

Association between funding source and study outcome in orthopaedic research. Clin Orthop Relat Res. 2003;415:293-301. doi:10.1097/01.blo.0000093888.12372.d9

67.

Lexchin

Bero

Djulbegovic

Clark

Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003;326(7400):1167-1170. doi:10.1136/bmj.326.7400.1167

68.

Zhou

Zhao

Chen

Hua

YH.

Strength of suture-button fixation versus ligament reconstruction in syndesmotic injury: a biomechanical study. Int Orthop. 2019;43(3):705-711. doi:10.1007/s00264-018-3935-6

69.

Lim

Choi

Kim

Lee

Kang

HS.

Dynamic fixation versus static screw fixation for syndesmosis injuries in pronation external rotation ankle fractures: a retrospective case control study. Malays Orthop J. 2023;17(3):48-58. doi:10.5704/MOJ.2311.008

70.

Lubberts

Vopat

Wolf

Longo

DiGiovanni

Guss

Arthroscopically measured syndesmotic stability after screw vs. suture button fixation in a cadaveric model. Injury. 2017;48(11):2433-2437. doi:10.1016/j.injury.2017.08.066

71.

Lurie

Paez

Howitt

Pennock

AT.

Suture-button versus screw fixation in adolescent syndesmotic injuries: functional outcomes and maintenance of reduction. J Pediatr Orthop. 2021;41(6):e427-e432. doi:10.1097/BPO.0000000000001803

72.

Meekaew

Paholpak

Wisanuyotin

Sirichativapee

Kosuwon

Kasai

Biomechanics comparison between EndoButton fixation and syndesmotic screw fixation for syndesmotic injury ankle fracture; a finite element analysis and cadaveric validation study. J Orthop. 2022;34:207-214. doi:10.1016/j.jor.2022.08.019

73.

Mercan

Yıldırım

Dere

Biomechanical analysis of tibiofibular syndesmosis injury fixation methods: a finite element analysis. J Foot Ankle Surg. 2023;62(1):107-114. doi:10.1053/j.jfas.2022.05.007

74.

Mick

Doll

Müller

, et al. Differences in gait analysis and clinical outcome after dynamic fixation or screw fixation in acute syndesmosis tear: a prospective randomized pilot study. Arch Orthop Trauma Surg. 2024;144(9):4355-4363. doi:10.1007/s00402-024-05535-8

75.

Morellato

Louati

Bodrogi

, et al. The effect of varying tension of a suture button construct in fixation of the tibiofibular syndesmosis-evaluation using stress computed tomography. J Orthop Trauma. 2017;31(2):103-110. doi:10.1097/BOT.0000000000000737

76.

Munsch

Chen

Dalton

Tisherman

Shaw

Lee

JY.

Association between industry sponsorship of spine-related clinical trials, publication status, and research outcomes. Global Spine J. 2024;14(7):2039-2044. doi:10.1177/21925682231166379

77.

Naqvi

Cunningham

Lynch

Galvin

Awan

Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828-2835. doi:10.1177/0363546512461480

78.

Naqvi

Shafqat

Awan

Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification. Injury. 2012;43(6):838-842. doi:10.1016/j.injury.2011.10.002

79.

Neary

Mormino

Wang

Suture button fixation versus syndesmotic screws in supination-external rotation type 4 injuries: a cost-effectiveness analysis. Am J Sports Med. 2017;45(1):210-217. doi:10.1177/0363546516664713

80.

Nishikawa

DRC

Saito

de Oliveira Junior

Mendes

AAM

Devito

Prado

. Clinical outcomes of isolated acute instability of the syndesmosis treated with arthroscopy and percutaneous suture-button fixation. Arch Orthop Trauma Surg. 2021;141(9):1567-1574. doi:10.1007/s00402-021-03813-3

81.

Obey

Schafer

Matheny

, et al. Syndesmotic suture button fixation results in higher Tegner activity scale scores when compared to screw fixation: a multicenter investigation. Foot Ankle Spec. 2024;17(3):270-276. doi:10.1177/19386400231174829

82.

O’Daly

Kreulen

Thamyongkit

, et al. Biomechanical evaluation of a new suture button technique for reduction and stabilization of the distal tibiofibular syndesmosis. Foot Ankle Orthop. 2020;5(4):2473011420969140. doi:10.1177/2473011420969140

83.

Page

de la Fuente

Stahl

Brennan

ML.

Clinical considerations to reduce saphenous neurovascular bundle injury during suture button fixation of syndesmosis injuries. J Orthop Trauma. 2020;34(2):e51-e55. doi:10.1097/BOT.0000000000001649

84.

Pang

Bedigrew

Palanca

Behn

Hunt

Chou

Ankle joint contact loads and displacement in syndesmosis injuries repaired with Tightropes compared to screw fixation in a static model. Injury. 2019;50(11):1901-1907. doi:10.1016/j.injury.2019.09.012

85.

Parker

Beason

Slowik

Sabatini

Waldrop

3rd . Biomechanical comparison of 3 syndesmosis repair techniques with suture button implants. Orthop J Sports Med. 2018;6(10):2325967118804204. doi:10.1177/2325967118804204

86.

Patel

Murphy

Pfeiffer

, et al. Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study. J Exp Orthop. 2020;7(1):18. doi:10.1186/s40634-020-00234-w

87.

Pavone

Papotto

Vescio

, et al. Short and middle functional outcome in the static vs. dynamic fixation of syndesmotic injuries in ankle fractures: a retrospective case series study. J Clin Med. 2023;12(11):3637. doi:10.3390/jcm12113637

88.

Peterson

Chapman

Hyer

Berlet

GC.

Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair. Foot Ankle Int. 2015;36(6):679-684. doi:10.1177/1071100715571631

89.

Pirozzi

Creech

Meyr

AJ.

Assessment of anatomic risk during syndesmotic stabilization with the suture button technique. J Foot Ankle Surg. 2015;54(5):917-919. doi:10.1053/j.jfas.2015.04.005

90.

Puddu

Cortese

Fantinato

, et al. Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): clinical and radiological evaluation in short-medium period. J Orthop. 2023;46:12-17. doi:10.1016/j.jor.2023.10.007

91.

Qamar

Kadakia

Venkateswaran

An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011;50(6):762-765. doi:10.1053/j.jfas.2011.07.001

92.

Ræder

Figved

Madsen

Frihagen

Jacobsen

Andersen

MR.

Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial. Bone Joint J. 2020;102-B(2):212-219. doi:10.1302/0301-620X.102B2.BJJ-2019-0692.R2

93.

Ræder

Stake

Madsen

, et al. Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years. Acta Orthop. 2020;91(6):770-775. doi:10.1080/17453674.2020.1818175

94.

Ramsey

Friess

DM.

Cost-effectiveness analysis of syndesmotic screw versus suture button fixation in tibiofibular syndesmotic injuries. J Orthop Trauma. 2018;32(6):e198-e203. doi:10.1097/BOT.0000000000001150

95.

Reb

Brandão

Watson

Van Dyke

Berlet

Prissel

MA.

Medial structure injury during suture button insertion using the center-center technique for syndesmotic stabilization. Foot Ankle Int. 2018;39(8):984-989. doi:10.1177/1071100718770200

96.

Ryan

Rodriguez

RM.

Outcomes and return to activity after operative repair of chronic latent syndesmotic instability. Foot Ankle Int. 2016;37(2):192-197. doi:10.1177/1071100715606488

97.

Sanders

Schneider

Taylor

Tieszer

Lawendy

AR.

Improved reduction of the tibiofibular syndesmosis with TightRope compared with screw fixation: results of a randomized controlled study. J Orthop Trauma. 2019;33(11):531-537. doi:10.1097/BOT.0000000000001559

98.

Saraglis

Khan

Chaudhari

Pyakurel

Elahi Rabbani

Arafa

Radiographic evaluation of syndesmosis stabilisation using the TightRope system versus syndesmotic screw fixation for the management of ankle fractures with a syndesmotic injury. Cureus. 2023;15(9):e45910. doi:10.7759/cureus.45910

99.

Schermann

Ogawa

Lubberts

, et al. Comparison of several combinations of suture tape reinforcement and suture button constructs for fixation of unstable syndesmosis. J Am Acad Orthop Surg. 2022;30(10):e769-e778. doi:10.5435/JAAOS-D-21-00508

100.

Schon

Williams

Venderley

, et al. A 3-D CT analysis of screw and suture-button fixation of the syndesmosis. Foot Ankle Int. 2017;38(2):208-214. doi:10.1177/1071100716673590

101.

Sertkaya

DeVries

Jessup

Beleche

Estimated cost of developing a therapeutic complex medical device in the US. JAMA Netw Open. 2022;5(9):e2231609. doi:10.1001/jamanetworkopen.2022.31609

102.

Shaath

Williams

Kelly

, et al. Clinical and radiographic results after treatment of traumatic syndesmotic instability using a novel screw-suture syndesmotic fixation device. J Orthop Trauma. 2024;38(8):e302-e306. doi:10.1097/BOT.0000000000002824

103.

Shoji

Teramoto

Suzuki

, et al. Suture-button fixation and anterior inferior tibiofibular ligament augmentation with suture-tape for syndesmosis injury: a biomechanical cadaveric study. Clin Biomech (Bristol). 2018;60:121-126. doi:10.1016/j.clinbiomech.2018.10.014

104.

Slim

Nini

Forestier

Kwiatkowski

Panis

Chipponi

Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712-716. doi:10.1046/j.1445-2197.2003.02748.x

105.

Soin

Knight

Dinah

Mears

Swierstra

Belkoff

SM.

Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison. Foot Ankle Int. 2009;30(4):346-352. doi:10.3113/FAI.2009.0346

106.

Song

Liao

Kuang

, et al. Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury: a case-control study. Medicine (Baltimore). 2020;99(34):e21573. doi:10.1097/MD.0000000000021573

107.

Spindler

Böcker

Polzer

Baumbach

SF.

A 3-ligament syndesmotic injury is at higher risk for malreduction than a 2-ligament injury: a CT-based analysis. Foot Ankle Int. 2024;45(8):812-821. doi:10.1177/10711007241238227

108.

Spindler

Gaube

Böcker

Polzer

Baumbach

SF.

Compensation of dynamic fixation systems in the quality of reduction of distal tibiofibular joint in acute syndesmotic complex injuries: a CT-based analysis. Foot Ankle Int. 2022;43(11):1393-1401. doi:10.1177/10711007221115193

109.

Stake

Bryniarski

Brady

, et al. Effect of posterior malleolar fixation on syndesmotic stability. Am J Sports Med. 2023;51(4):997-1006. doi:10.1177/03635465231151448

110.

Takahashi

Teramoto

Murahashi

, et al. Comparison of treatment methods for syndesmotic injuries with posterior tibiofibular ligament ruptures: a cadaveric biomechanical study. Orthop J Sports Med. 2022;10(9):23259671221122811. doi:10.1177/23259671221122811

111.

Teramoto

Suzuki

Kamiya

Chikenji

Watanabe

Yamashita

Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med. 2011;39(10):2226-2232. doi:10.1177/0363546511413455

112.

Thornes

Shannon

Guiney

Hession

Masterson

Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431:207-212.

113.

Verlinsky

Heath

Momtaz

Christopher

Singh

Gibbons

SD.

A comparison of screw and suture button fixation in the management of adolescent ankle syndesmotic injuries. J Child Orthop. 2024;18(3):295-301. doi:10.1177/18632521241238889

114.

Wang

Song

Cui

Zhang

YZ.

Biomechanical comparison of bionic, screw and EndoButton fixation in the treatment of tibiofibular syndesmosis injuries. Int Orthop. 2016;40(2):307-314. doi:10.1007/s00264-015-2920-6

115.

Weber

Hull

Johnson

Henn

3rd . Cost analysis of ankle syndesmosis internal fixation. J Clin Orthop Trauma. 2019;10(1):173-177. doi:10.1016/j.jcot.2017.08.008

116.

Wei

Jing

Shu

Tong

Wang

JH.

Self-made wire-rope button plate: a novel option for the treatment of distal tibiofibular syndesmosis separation. J Orthop Surg (Hong Kong). 2021;29(1):2309499020975215. doi:10.1177/2309499020975215

117.

Weng

Lin

Liu

Dai

Lutchooman

Hong

Biomechanical analysis of a novel syndesmotic plate compared with traditional screw and suture button fixation. J Foot Ankle Surg. 2020;59(3):522-528. doi:10.1053/j.jfas.2019.07.025

118.

Westermann

Rungprai

Goetz

Femino

Amendola

Phisitkul

The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study. J Bone Joint Surg Am. 2014;96(20):1732-1738. doi:10.2106/JBJS.N.00198

119.

Wilke

Krause

Niederer

, et al. Appraising the methodological quality of cadaveric studies: validation of the QUACS scale. J Anat. 2015;226(5):440-446. doi:10.1111/joa.12292

120.

Willmott

Singh

David

LA.

Outcome and complications of treatment of ankle diastasis with tightrope fixation. Injury. 2009;40(11):1204-1206. doi:10.1016/j.injury.2009.05.008

121.

Wolfson

Struhl

Continuous loop double cortical button technique for distal tibiofibular syndesmosis stabilization: a technical note and case series. Tech Foot Ankle Surg. 2020;19(2):104-113. doi:10.1097/BTF.0000000000000264

122.

Wong

Wiens

LaMothe

Edwards

Schneider

PS.

In vivo syndesmotic motion after rigid and flexible fixation using 4-dimensional computerized tomography. J Orthop Trauma. 2022;36(5):257-264. doi:10.1097/BOT.0000000000002267

123.

Wood

Arshad

Kim

Stewart

Kinematic analysis of combined suture-button and suture anchor augment constructs for ankle syndesmosis injuries. Foot Ankle Int. 2020;41(4):463-472. doi:10.1177/1071100719898181

124.

Chen

Zhang

Wang

Zhang

Flexible fixation of syndesmotic diastasis using the assembled bolt-tightrope system. Scand J Trauma Resusc Emerg Med. 2013;21:71. doi:10.1186/1757-7241-21-71

125.

Zhang

, et al. Comparison of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury: a meta-analysis. J Foot Ankle Surg. 2021;60(3):555-566. doi:10.1053/j.jfas.2020.08.005

126.

Kang

, et al. The clinical efficacy of suture-button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury: a retrospective study. J Foot Ankle Surg. 2022;61(1):143-148. doi:10.1053/j.jfas.2021.07.009

127.

Yang

Iorio

Day

CS.

Orthopaedic device approval through the premarket approval process: a financial feasibility analysis for a single center. J Bone Joint Surg Am. 2017;99(6):e26. doi:10.2106/jbjs.16.00050

128.

Yang

Chen

Liu

Wang

Zhao

Guan

Clinical study of a steel cable fixation for distal tibiofibular syndesmosis injury. Medicine (Baltimore). 2023;102(42):e35691. doi:10.1097/md.0000000000035691

129.

Yawar

Hanratty

Asim

Niazi

Khan

AM.

Suture-button versus syndesmotic screw fixation of ankle fractures: a comparative retrospective review over one year. Cureus. 2021;13(9):e17826. doi:10.7759/cureus.17826

130.

Zayed

Hammouda

Yasseen

Hashim

MMA

. The use of suspensory fixation for ankle syndesmotic injuries: a modified technique. J Limb Lengthening Reconstr. 2020;6(1):48-53. doi:10.4103/jllr.jllr_2_20

131.

Zhang

Xiong

Zhou

Xiong

Biomechanical comparison of screw, tightrope and novel double EndoButton in the treatment of tibiofibular syndesmotic injuries. Injury. 2021;52(10):2813-2819. doi:10.1016/j.injury.2021.06.011

132.

Zhang

Tang

Zhou

Wang

A novel adjustable EndoButton fixation assisted by 3D printing technology for tibiofibular syndesmosis injury: a biomechanical study. Front Bioeng Biotechnol. 2022;10:793866. doi:10.3389/fbioe.2022.793866

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