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What Is Ankle Syndesmosis Repair?

Ankle syndesmosis repair is surgery used to restore stability between the lower ends of the tibia and fibula after an unstable syndesmotic injury. The syndesmosis is a group of ligaments that holds these bones in proper relationship above the ankle joint. Repair restores the normal spacing and alignment of the distal tibiofibular joint. Fixation is commonly achieved with one or more screws or a flexible suture-button construct.

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What Is Ankle Syndesmosis Repair?

Ankle syndesmosis repair is surgery used to restore stability between the lower ends of the tibia and fibula after an unstable syndesmotic injury. The syndesmosis is a group of ligaments that holds these bones in proper relationship above the ankle joint. Repair restores the normal spacing and alignment of the distal tibiofibular joint. Fixation is commonly achieved with one or more screws or a flexible suture-button construct.

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Why Is Ankle Syndesmosis Repair Performed?

Surgery is performed when the syndesmosis is unstable or widened enough that the tibia and fibula cannot maintain normal ankle alignment. This can occur with a severe high ankle sprain or together with ankle fractures. Stable ligament injuries can often heal without surgery, while unstable injuries require reduction and fixation to protect ankle mechanics. The treatment plan also addresses associated fractures, cartilage injuries, or ligament damage.

How Is Ankle Syndesmosis Repair Performed?

The surgeon restores the fibula and tibia to their normal relationship using direct visualization, fluoroscopy, arthroscopy, or a combination of methods. Once the syndesmosis is reduced, fixation is passed across the distal tibia and fibula to hold the bones together while the ligaments heal. Rigid fixation uses one or more syndesmotic screws, while flexible fixation uses a suture-button device that permits small physiologic motion. Associated ankle fractures are repaired during the same operation when present.

What Is Recovery Like After Ankle Syndesmosis Repair?

The ankle is protected in a splint, cast, or boot while the repaired ligaments and any fractures heal. Weight-bearing is restricted initially in many cases and then increased according to healing, fixation method, and associated injuries. Physical therapy works on ankle motion, strength, balance, and a gradual return to walking, running, and sport. Recovery from a syndesmotic injury often takes longer than recovery from a routine lateral ankle sprain.

What Are the Risks and Complications?

Possible complications include infection, blood clots, stiffness, persistent pain, recurrent instability, and injury to nearby nerves or blood vessels. Poor reduction of the syndesmosis can alter ankle mechanics and contribute to ongoing pain or arthritis. Screws can loosen or break, and some patients undergo later screw removal, while suture-button devices can also cause irritation or require revision. Associated fractures or cartilage damage can affect long-term recovery even when the syndesmosis heals.

Frequently Asked Questions About Ankle Syndesmosis Repair

Is ankle syndesmosis repair used for a high ankle sprain?

Yes. Surgery is used for selected high ankle sprains when the syndesmosis is unstable or widened. Stable injuries are commonly treated without surgery.

What is the difference between a syndesmotic screw and a suture button?

A screw provides rigid fixation across the tibia and fibula, while a suture-button construct provides flexible stabilization that permits small physiologic movement.

Do syndesmotic screws always have to be removed?

No. Some screws remain in place without problems, while others are removed for symptoms, breakage, motion concerns, or surgeon preference.

Can the syndesmosis become unstable again after repair?

Yes. Recurrent widening or instability can occur if fixation fails, the ligaments do not heal adequately, or another injury occurs.

References

Ankle Syndesmosis Surgery Procedure & Recovery. FootCareMD, American Orthopaedic Foot & Ankle Society. https://www.footcaremd.org/foot-and-ankle-treatments/ankle/syndesmosis-surgery. Date Accessed August 13, 2026.

High Ankle Sprain (Syndesmotic Injury). FootCareMD, American Orthopaedic Foot & Ankle Society. https://www.footcaremd.org/foot-and-ankle-conditions/ankle/high-ankle-sprain. Date Accessed August 13, 2026.

Sprained Ankle. OrthoInfo, American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/. Date Accessed August 13, 2026.

Optimal management of ankle syndesmosis injuries. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC4128849/. Date Accessed August 13, 2026.

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials. PubMed. https://pubmed.ncbi.nlm.nih.gov/30475639/. Date Accessed August 13, 2026.