{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:31:10Z","timestamp":1787445070051,"version":"build-2736575974"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"abstract":"<jats:p>Background. Chronic syndesmotic instability alters normal ankle biomechanics and impairs load distribution, potentially leading to degenerative arthritis. The aim of this study was to describe a technical tip for the treatment of chronic tibiofibular instability using a triple-fixation construct, combining a suture button and FiberTape. Methods. We described the triple-fixation technique and reviewed the cases of 3 patients, aged 22, 25, and 53 years, all diagnosed with chronic syndesmotic instability associated with incongruence of the distal tibiofibular joint. Results. The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were 54, 73, and 77, respectively. Postoperatively, all patients achieved a score of 100. The mean follow-up periods were 11, 14, and 17 months, respectively. One patient reported mild discomfort at the suture-button knot site, but no other complications were reported. Conclusion. The triple-fixation technique proved effective in stabilizing chronic syndesmotic injuries in all cases presented. This construct may be considered a viable option for addressing residual instability in patients with chronic distal tibiofibular joint lesions. However, these findings should be interpreted within the context of the study\u2019s limitations, including its technical-tip design, small cohort size, relatively short follow-up for a chronic pathology, and lack of randomization.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Level of Evidence:<\/jats:bold>\n                    V, technical tip and case report\n                  <\/jats:p>","DOI":"10.1177\/19386400251407174","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T12:34:31Z","timestamp":1767443671000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Flexible Triple Fixation for Chronic Syndesmotic Instability: A Technical Tip"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0227-2440","authenticated-orcid":false,"given":"Danilo Ryuko C\u00e2ndido","family":"Nishikawa","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor P\u00fablico Municipal de S\u00e3o Paulo (HSPM), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1211-9258","authenticated-orcid":false,"given":"Guilherme Honda","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital S\u00edrio-Liban\u00eas, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Jardim","family":"Fairbanks","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Abussamra Moreira","family":"Mendes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Pires","family":"Prado","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1083-7515(02)00022-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-015-2371-y"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2006.07.006"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715583456"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.0336"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-037239"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v2.i1.1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.210017"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07849-5"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715606488"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199506000-00005"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80015-5"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2024.102382"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2016-000058"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2015.06.009"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118804204"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2020.06.002"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2018.08.008"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1311-1"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2008.04.002"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2515-y"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2009.0506"}],"container-title":["Foot &amp; 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