{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:11:22Z","timestamp":1793095882469,"version":"4.5.0"},"reference-count":9,"publisher":"Human Kinetics","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,1]]},"abstract":"Clinical Scenario<\/jats:bold><\/jats:italic>: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope\u2122<\/jats:sup>, has gained popularity in treating ankle syndesmosis injuries. The TightRope\u2122<\/jats:sup> involves inserting Fiberwire\u00ae<\/jats:sup> through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question<\/jats:bold><\/jats:italic>: In patients suffering from ankle syndesmosis injuries, is the Tightrope\u2122<\/jats:sup> ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings<\/jats:bold><\/jats:italic>: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope\u2122<\/jats:sup> fixation. Clinical Bottom Line<\/jats:bold><\/jats:italic>: There is moderate evidence to support the use of the TightRope\u2122<\/jats:sup> syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation<\/jats:bold><\/jats:italic>: Grade A evidence exists in support of using the TightRope\u2122<\/jats:sup> fixation system in place of the metallic screw following ankle syndesmosis injury.<\/jats:p>","DOI":"10.1123\/jsr.2020-0265","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T07:32:52Z","timestamp":1614151972000},"page":"676-679","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness of the TightRope\u00ae Fixation in Treating Ankle Syndesmosis Injuries: A Critically Appraised Topic"],"prefix":"10.1123","volume":"30","author":[{"given":"Scott Benson","family":"Street","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Rawlins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"100","reference":[{"issue":"5","key":"r1","series-title":"J Foot Ankle Surg.","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1053\/j.jfas.2014.03.011","article-title":"Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011)","volume":"53","author":"Shibuya N","year":"2014","unstructured":"Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg. 2014;53(5):606\u2013608. doi:10.1053\/j.jfas.2014.03.0112478520210.1053\/j.jfas.2014.03.011"},{"issue":"12","key":"r2","series-title":"Am J Sports Med.","doi-asserted-by":"publisher","first-page":"2828","DOI":"10.1177\/0363546512461480","article-title":"Comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction","volume":"40","author":"Naqvi GA","year":"2012","unstructured":"Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828\u20132835. PubMed ID: 23051785 doi:10.1177\/03635465124614802305178510.1177\/0363546512461480"},{"issue":"10","key":"r3","series-title":"Knee Surg Sports Traumatol Arthrosc","doi-asserted-by":"publisher","first-page":"3156","DOI":"10.1007\/s00167-017-4820-3","article-title":"Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device","volume":"26","author":"Colcuc C","year":"2018","unstructured":"Colcuc C, Blank M, Stein T, et\u00a0al. 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\u20133164. PubMed ID: 29224059 doi:10.1007\/s00167-017-4820-32922405910.1007\/s00167-017-4820-3"},{"issue":"2","key":"r4","series-title":"Sports Health.","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1177\/1941738118816282","article-title":"Return to sport after ankle syndesmotic injury: a systematic review","volume":"11","author":"Vancolen SY","year":"2019","unstructured":"Vancolen SY, Nadeem I, Horner NS, Johal H, Alolabi B, Khan M. Return to sport after ankle syndesmotic injury: a systematic review. Sports Health. 2019;11(2):116\u2013122. PubMed ID: 30550364 doi:10.1177\/194173811881628210.1177\/194173811881628230550364"},{"issue":"6","key":"r5","series-title":"Int Orthop.","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1007\/s00264-012-1500-2","article-title":"Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair","volume":"36","author":"Schepers T","year":"2012","unstructured":"Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36(6):1199\u20131206. PubMed ID: 22318415 doi:10.1007\/s00264-012-1500-210.1007\/s00264-012-1500-222318415"},{"issue":"2","key":"r6","series-title":"Tech Orthop.","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/BTO.0000000000000226","article-title":"Ankle syndesmotic injuries: a systematic review","volume":"32","author":"Levy DM","year":"2017","unstructured":"Levy DM, Reid K, Gross CE. Ankle syndesmotic injuries: a systematic review. Tech Orthop. 2017;32(2):80\u201383. doi:10.1097\/BTO.000000000000022610.1097\/BTO.0000000000000226"},{"issue":"1","key":"r7","series-title":"SA Orthop J.","first-page":"32","article-title":"Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs TightRope\u2122 fiberwire fixation\u2014medium term results","volume":"8","author":"Coetzee JC","year":"2009","unstructured":"Coetzee JC, Ebeling PB. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs TightRope\u2122 fiberwire fixation\u2014medium term results. SA Orthop J. 2009;8(1):32\u201337."},{"issue":"1","key":"r8","series-title":"Tech Foot Ankle Surg.","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/00132587-200603000-00010","article-title":"Ankle syndesmosis injuries treated with the TightRope\u2122 Suture-Button Kit","volume":"5","author":"Thornes B","year":"2006","unstructured":"Thornes B, McCartan DMB. Ankle syndesmosis injuries treated with the TightRope\u2122 Suture-Button Kit. Tech Foot Ankle Surg. 2006;5(1):45\u201353. doi:10.1097\/00132587-200603000-0001010.1097\/00132587-200603000-00010"},{"issue":"11","key":"r9","series-title":"Orthopedics","doi-asserted-by":"publisher","first-page":"e1378","DOI":"10.3928\/01477447-20131021-18","article-title":"Syndesmosis and lateral ankle sprains in the National Football League","volume":"36","author":"Osbahr DC","year":"2013","unstructured":"Osbahr DC, Drakos MC, O\u2019Loughlin PF, et al. Syndesmosis and lateral ankle sprains in the National Football League. Orthopedics. 2013;36(11):e1378\u2013e1384. 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