{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:58:10Z","timestamp":1793354290170,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["arthroscopysportsmedicineandrehabilitation.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate patient\u2010reported outcomes after arthroscopic suture\u2010button repair of chronic isolated syndesmotic injuries and to compare the diagnostic sensitivity of standard imaging with arthroscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with chronic (\u22653 months) syndesmotic injuries confirmed by arthroscopy (\u22652 mm widening) who underwent suture\u2010button repair between 2017 and 2021 were included. Exclusion criteria were ankle fractures, previous major surgery, or significant arthritis. Foot Function Index and Foot\u2010and\u2010Ankle Ability Measure scores were recorded preoperatively as part of routine clinical assessment and at final follow\u2010up. The minimal clinically important difference was defined as 75% of preoperative standard deviation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010one patients (43 ankles) were analyzed. Median age was 32 years (15\u201057 years), 63% were female, and time from injury to surgery was 1.7 years (0.25\u201025). Fifteen ankles (35%) received concomitant lateral suture\u2010tape stabilization. Arthroscopic syndesmotic widening was 2\u20103 mm in 5%, 3\u20104 mm in 10%, &gt;4 mm in 46%, and posterior in 38%. All 6 Foot Function Index and Foot\u2010and\u2010Ankle Ability Measure subscores improved significantly (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), with 79% to 93% achieving minimal clinically important difference at a median 2.3\u2010year follow\u2010up (1.0\u20104.8). Sensitivity for syndesmotic pathology was 5% for radiographs and stress fluoroscopy, 22% for computed tomography, and 26% for magnetic resonance imaging.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Arthroscopic suture\u2010button repair led to significant improvements in patient\u2010reported outcomes for chronic isolated syndesmotic injuries. Standard imaging had low sensitivity, and a posterior\u2010predominant syndesmotic widening pattern was commonly observed arthroscopically. These findings suggest that chronic syndesmotic instability is underdiagnosed, highlight the role of arthroscopic evaluation for accurate diagnosis, and support the use of suture\u2010button stabilization as an effective treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, therapeutic case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2025.101227","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T23:44:18Z","timestamp":1753832658000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Suture\u2010Button Repair Improves Outcomes in Arthroscopically Diagnosed Chronic Syndesmotic Injury Despite Low Imaging Sensitivity"],"prefix":"10.1002","volume":"7","author":[{"given":"Tarjei","family":"Vinje","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eivind","family":"Inderhaug","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"Norwegian Arthroplasty Register Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Jarning","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi M.","family":"Hole","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"},{"name":"Norwegian Arthroplasty Register Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Vetti","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"Department of Radiology Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merete A.","family":"Malt","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjell","family":"Matre","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"Norwegian Arthroplasty Register Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01537"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/emj.20.6.508"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-23-00707"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-447-17"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507302545"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-13-00135"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241271593"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097710"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.12708"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098106"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092787"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079001000607"},{"key":"e_1_2_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2018.08.008"},{"key":"e_1_2_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-017-2823-2"},{"key":"e_1_2_3_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8070968"},{"key":"e_1_2_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06067-5"},{"key":"e_1_2_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716688198"},{"key":"e_1_2_3_19_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.01011"},{"issue":"3","key":"e_1_2_3_20_2","article-title":"Physical examination of the ankle: A review of the original orthopedic special test description and scientific validity of common tests for ankle examination","volume":"2","author":"Larkins LW","year":"2020","journal-title":"Arch Rehabil Res Clin Transl"},{"key":"e_1_2_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1089-1"},{"key":"e_1_2_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2015.12.006"},{"key":"e_1_2_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/BTF.0000000000000111"},{"key":"e_1_2_3_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000062554.74615.4C"},{"key":"e_1_2_3_25_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.47B4.678"},{"key":"e_1_2_3_26_2","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200029050-00005"},{"key":"e_1_2_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-199901000-00008"},{"key":"e_1_2_3_28_2","doi-asserted-by":"publisher","DOI":"10.21037\/aoj-24-31"},{"key":"e_1_2_3_29_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.210017"},{"key":"e_1_2_3_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007231153388"},{"key":"e_1_2_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(00)00020-6"},{"key":"e_1_2_3_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3454-y"},{"key":"e_1_2_3_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06089-z"},{"key":"e_1_2_3_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715606488"},{"key":"e_1_2_3_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011419852930"},{"key":"e_1_2_3_36_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.0841"},{"key":"e_1_2_3_37_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.0336"}],"container-title":["Arthroscopy, Sports Medicine, and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666061X25001531?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666061X25001531?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.asmr.2025.101227","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.asmr.2025.101227","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.asmr.2025.101227","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:07:41Z","timestamp":1778155661000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.asmr.2025.101227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1016\/j.asmr.2025.101227"],"URL":"https:\/\/doi.org\/10.1016\/j.asmr.2025.101227","archive":["Portico"],"relation":{},"ISSN":["2666-061X","2666-061X"],"issn-type":[{"value":"2666-061X","type":"print"},{"value":"2666-061X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Suture-Button Repair Improves Outcomes in Arthroscopically Diagnosed Chronic Syndesmotic Injury Despite Low Imaging Sensitivity","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy, Sports Medicine, and Rehabilitation","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.asmr.2025.101227","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America\u00e9","name":"copyright","label":"Copyright"}],"article-number":"101227"}}