The anterior inferior tibiofibular ligament (AiTFL) is the primary lateral ligamentous stabilizer of the ankle syndesmosis. Current syndesmosis repair techniques traverse the tibia and fibula, but do not anatomically reconstruct the AiTFL. We compared a novel AiTFL anatomic repair technique (ART) to rigid syndesmosis screw fixation (SCREW). Twelve cadaveric below knee specimens were compared radiographically and using a biomechanical testing protocol. All specimens underwent a CT scan of the ankle joint prior to testing. Next, the AiTFL, interosseous membrane and deltoid ligament were sectioned, and the posterior malleolus osteotomized, to recreate a trimalleolar-equivalent ankle fracture. The posterior malleolus was repaired with the posterior ligamentous insertions intact and functional (PMALL). Ankles were examined under fluoroscopy with an external rotation stress exam and the medial clear space (MCS) measured. Specimens were then randomized to receive either a conventional syndesmosis screw (SCREW), or the novel anatomic repair technique (ART). External rotation stress fluoroscopy was repeated. A second CT was completed and the fibular position compared to the pre-injury CT. Each specimen was then loaded in external rotation until failure using a custom biomechanical jig.Purpose
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