{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:33:43Z","timestamp":1786448023309,"version":"build-2736575974"},"reference-count":56,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Soonchunhyang University Research Fund","award":["2026-0038"],"award-info":[{"award-number":["2026-0038"]}]},{"award":["2026-0038"],"award-info":[{"award-number":["2026-0038"]}],"id":[{"id":"https:\/\/ror.org\/03qjsrb10","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: In high-grade syndesmotic injuries involving combined disruption of the anterior inferior tibiofibular ligament (AITFL) and posterior inferior tibiofibular ligament (PITFL), most suture-tape augmentation techniques have focused on the AITFL alone. This study evaluated the clinical and radiologic outcomes of a suture-tape-only anterior and posterior (A-P) augmentation technique, with a primary focus on technical feasibility and maintenance of syndesmotic reduction. Methods: We retrospectively reviewed consecutive patients who underwent A-P syndesmotic augmentation using nonabsorbable suture tape, based on clinical and radiologic data available from January 2022 through April 2026. Complete disruption of both the AITFL and PITFL was confirmed arthroscopically and by direct visualization. Clinical outcomes were assessed using the Olerud\u2013Molander Ankle Score (OMAS) and visual analog scale (VAS) preoperatively and at the 1-year postoperative assessment. Syndesmotic reduction was evaluated on bilateral computed tomography (CT) scans obtained 1 year postoperatively using the direct anterior difference (DAD), direct posterior difference (DPD), fibular translation (FT), and fibular rotation (FR), with the uninjured contralateral ankle serving as the reference. Results: Seven patients (mean age, 35.1 years; mean follow-up, 26.3 months) were included. At the 1-year postoperative assessment, the mean OMAS increased from 1.4 \u00b1 3.8 to 86.4 \u00b1 5.6, whereas the mean VAS score decreased from 8.1 \u00b1 0.7 to 0.3 \u00b1 0.5 (both p = 0.016), with preoperative scores obtained in the acute injury setting. For both observers, no individual absolute side-to-side difference exceeded the predefined malreduction threshold for any of the four CT parameters. Bony union was achieved in all cases. One patient developed a superficial wound complication, and no reoperations were required. Conclusions: In this small, selected case series, A-P suture-tape augmentation was technically feasible, and syndesmotic reduction was maintained at 1 year postoperatively in patients with combined AITFL and PITFL injuries. These preliminary findings warrant further evaluation in larger comparative studies.<\/jats:p>","DOI":"10.3390\/jcm15166217","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:32:16Z","timestamp":1786444336000},"page":"6217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and CT-Based Outcomes of Anterior and Posterior Syndesmotic Augmentation Using Nonabsorbable Suture Tape for Acute Syndesmotic Instability: A Preliminary Case Series of Seven Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9831-2565","authenticated-orcid":false,"given":"Dae-Woong","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7844-3552","authenticated-orcid":false,"given":"Eui-Dong","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8777-0603","authenticated-orcid":false,"given":"Ki Jin","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Hwa","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6468-1456","authenticated-orcid":false,"given":"Sung Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13449, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7220-3868","authenticated-orcid":false,"given":"Jae Young","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4157-3414","authenticated-orcid":false,"given":"Dhong-Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4579-1008","authenticated-orcid":false,"given":"Woo-Jong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1530\/EOR-23-0097","article-title":"A systematic review of studies on the diagnostics and classification system used in surgically treated, acute, isolated, unstable syndesmotic injury: A plea for uniform definition of syndesmotic injuries","volume":"9","author":"Spindler","year":"2024","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Regauer, M., Mackay, G., Nelson, O., Bocker, W., and Ehrnthaller, C. (2022). Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020331"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.ocl.2019.02.004","article-title":"Anatomic Ligament Repairs of Syndesmotic Injuries","volume":"50","author":"Akoh","year":"2019","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/BOT.0000000000001485","article-title":"Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries","volume":"33","author":"Andersen","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/j.1469-7580.2010.01302.x","article-title":"Anatomy of the distal tibiofibular syndesmosis in adults: A pictorial essay with a multimodality approach","volume":"217","author":"Hermans","year":"2010","journal-title":"J. Anat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"356","DOI":"10.2106\/00004623-197658030-00010","article-title":"Changes in tibiotalar area of contact caused by lateral talar shift","volume":"58","author":"Ramsey","year":"1976","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/BOT.0b013e31822a526a","article-title":"The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up","volume":"26","author":"Sagi","year":"2012","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1177\/107110079301400308","article-title":"Tibiotalar joint dynamics: Indications for the syndesmotic screw--a cadaver study","volume":"14","author":"Burns","year":"1993","journal-title":"Foot Ankle"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.morpho.2021.10.004","article-title":"Distal tibiofibular syndesmosis: A meta-analysis of cadaveric studies","volume":"106","author":"Yammine","year":"2022","journal-title":"Morphologie"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1053\/j.jfas.2013.03.025","article-title":"Complications of distal tibiofibular syndesmotic screw stabilization: Analysis of 236 patients","volume":"52","author":"Kloen","year":"2013","journal-title":"J. Foot Ankle Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1302\/2058-5241.2.160084","article-title":"Management of syndesmotic injuries of the ankle","volume":"2","author":"Alvarez","year":"2017","journal-title":"EFORT Open Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1177\/1938640019843328","article-title":"Revision of Syndesmosis Screw Fixation","volume":"13","author":"Bafna","year":"2020","journal-title":"Foot Ankle Spec."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/1938640020932049","article-title":"Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage","volume":"15","author":"Ibrahim","year":"2022","journal-title":"Foot Ankle Spec."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lim, B., Shaalan, M., O\u2019HEireamhoin, S., and Lyons, F. (2024). Syndesmotic fixation in Weber B ankle fractures: A systematic review. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0304148"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1016\/j.injury.2015.05.027","article-title":"Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures","volume":"46","author":"Seyhan","year":"2015","journal-title":"Injury"},{"key":"ref_16","first-page":"e17826","article-title":"Suture-Button Versus Syndesmotic Screw Fixation of Ankle Fractures: A Comparative Retrospective Review Over One Year","volume":"13","author":"Yawar","year":"2021","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zhang, P., Liang, Y., He, J., Fang, Y., Chen, P., and Wang, J. (2017). A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1645-7"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1007\/s11845-024-03619-3","article-title":"Syndesmotic injury with ankle fracture: A systematic review of screw vs dynamic fixation","volume":"193","author":"Murphy","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.fcl.2023.10.002","article-title":"Syndesmotic Malreduction Prevention, Assessment, and Treatment","volume":"30","author":"Baumbach","year":"2025","journal-title":"Foot Ankle Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1177\/10711007221115193","article-title":"Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis","volume":"43","author":"Spindler","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1177\/10711007241238227","article-title":"A 3-Ligament Syndesmotic Injury Is at Higher Risk for Malreduction Than a 2-Ligament Injury: A CT-Based Analysis","volume":"45","author":"Spindler","year":"2024","journal-title":"Foot Ankle Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1177\/03635465231151448","article-title":"Effect of Posterior Malleolar Fixation on Syndesmotic Stability","volume":"51","author":"Stake","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/1071100716666278","article-title":"Biomechanical Comparison of 3 Current Ankle Syndesmosis Repair Techniques","volume":"38","author":"Clanton","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1177\/1071100718786500","article-title":"Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress","volume":"39","author":"Goetz","year":"2018","journal-title":"Foot Ankle Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1177\/1071100716681605","article-title":"3D Model Analysis of Ankle Flexion on Anatomic Reduction of a Syndesmotic Injury","volume":"38","author":"Schon","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1177\/10711007221082933","article-title":"Anterior Inferior Tibiofibular Ligament Suture Tape Augmentation for Isolated Syndesmotic Injuries","volume":"43","author":"Jamieson","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103418","DOI":"10.1016\/j.eats.2024.103418","article-title":"Arthroscopic Reconstruction of the Posteroinferior Tibiofibular Ligament: An Operative Technique","volume":"14","author":"Mioduszewski","year":"2025","journal-title":"Arthrosc. Tech."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1053\/j.jfas.2020.04.021","article-title":"Comparison of Open Anterior Syndesmotic Repair Augmented With Suture-Tape and Trans-syndesmotic Screw Fixation: A Biomechanical Study","volume":"60","author":"Lee","year":"2021","journal-title":"J. Foot Ankle Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1177\/1071100720951172","article-title":"Anterior Syndesmotic Augmentation Technique Using Nonabsorbable Suture-Tape for Acute and Chronic Syndesmotic Instability","volume":"41","author":"Kwon","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yoon, S.J., Jung, K.J., Hong, Y.C., Yeo, E.D., Lee, H.S., Won, S.H., Lee, B.R., Ji, J.Y., Lee, D.W., and Kim, W.J. (2023). Anatomical Augmentation Using Suture Tape for Acute Syndesmotic Injury in Maisonneuve Fracture: A Case Report. Medicina, 59.","DOI":"10.3390\/medicina59040652"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lee, S.W., Yoon, S.J., Jung, K.J., Yeo, E.D., Won, S.H., Hong, C.H., Wang, S.D., Cho, Y.C., Ji, J.Y., and Byeon, J.Y. (2025). Anterior and Posterior Syndesmotic Augmentation Using Nonabsorbable Suture Tape for Acute Syndesmotic Instability: A Technical Note. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072207"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.physio.2021.03.015","article-title":"An evaluation of the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture","volume":"112","author":"McKeown","year":"2021","journal-title":"Physiotherapy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/BOT.0b013e3182a59b3c","article-title":"Posterior translation of the fibula may indicate malreduction: CT study of normal variation in uninjured ankles","volume":"28","author":"Pakarinen","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.2106\/JBJS.O.00016","article-title":"The Measurement and Clinical Importance of Syndesmotic Reduction After Operative Fixation of Rotational Ankle Fractures","volume":"97","author":"Warner","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-0844.R1","article-title":"Assessment of malreduction standards for the syndesmosis in bilateral CT scans of uninjured ankles","volume":"103-b","author":"Kubik","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00005131-200502000-00006","article-title":"Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures","volume":"19","author":"Weening","year":"2005","journal-title":"J. Orthop. Trauma"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2828","DOI":"10.1177\/0363546512461480","article-title":"Fixation of ankle syndesmotic injuries: Comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction","volume":"40","author":"Naqvi","year":"2012","journal-title":"Am. J. Sports Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/BOT.0b013e3182535f30","article-title":"Normal tibiofibular relationships at the syndesmosis on axial CT imaging","volume":"26","author":"Dikos","year":"2012","journal-title":"J. Orthop. Trauma"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/BOT.0000000000001559","article-title":"Improved Reduction of the Tibiofibular Syndesmosis With TightRope Compared With Screw Fixation: Results of a Randomized Controlled Study","volume":"33","author":"Sanders","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"24730114211012701","DOI":"10.1177\/24730114211012701","article-title":"Biomechanics of the Distal Tibiofibular Syndesmosis: A Systematic Review of Cadaveric Studies","volume":"6","author":"Khambete","year":"2021","journal-title":"Foot Ankle Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/0363546514554911","article-title":"Ankle syndesmosis: A qualitative and quantitative anatomic analysis","volume":"43","author":"Williams","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s00167-010-1100-x","article-title":"Anatomy of the ankle ligaments: A pictorial essay","volume":"18","author":"Vega","year":"2010","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/S0749-8063(05)80014-3","article-title":"Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints","volume":"10","author":"Reed","year":"1994","journal-title":"Arthroscopy"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1177\/1071100716666277","article-title":"Biomechanical Analysis of the Individual Ligament Contributions to Syndesmotic Stability","volume":"38","author":"Clanton","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"23259671221122811","DOI":"10.1177\/23259671221122811","article-title":"Comparison of Treatment Methods for Syndesmotic Injuries With Posterior Tibiofibular Ligament Ruptures: A Cadaveric Biomechanical Study","volume":"10","author":"Takahashi","year":"2022","journal-title":"Orthop. J. Sports Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"523","DOI":"10.4055\/cios24432","article-title":"Posterior Inferior Tibiofibular Ligament Periosteal Sleeve Avulsion: New Classification for Posterior Malleolar Fracture of the Ankle","volume":"17","author":"Kim","year":"2025","journal-title":"Clin. Orthop. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"256","DOI":"10.13107\/jocr.2025.v15.i08.5960","article-title":"Chronic Syndesmotic Instability Associated with a Complex Lesion of the Posterior Inferior Tibiofibular Ligament: Review, Case Report, and Surgical Report","volume":"15","author":"Perez","year":"2025","journal-title":"J. Orthop. Case Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1007\/s00167-015-3942-8","article-title":"Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines","volume":"24","author":"Longo","year":"2016","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Shiwaku, K., Teramoto, A., Iba, K., Otsubo, H., Kamiya, T., Shoji, H., Watanabe, K., and Yamashita, T. (2022). The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: A retrospective study. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05220-0"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1007\/s00167-019-05581-5","article-title":"MRI for high ankle sprains with an unstable syndesmosis: Posterior malleolus bone oedema is common and time to scan matters","volume":"27","author":"Randell","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/107110079401500801","article-title":"Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: A prospective clinical study","volume":"15","author":"Yamaguchi","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2106\/00004623-200201000-00005","article-title":"Treatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation","volume":"84","author":"Hovis","year":"2002","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1016\/j.injury.2021.06.025","article-title":"Suture button versus syndesmosis screw fixation in pronation-external rotation ankle fractures: A minimum 6-year follow-up of a randomised controlled trial","volume":"52","author":"Lehtola","year":"2021","journal-title":"Injury"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"301","DOI":"10.5312\/wjo.v8.i4.301","article-title":"Syndesmotic InternalBrace(TM) for anatomic distal tibiofibular ligament augmentation","volume":"8","author":"Regauer","year":"2017","journal-title":"World J. Orthop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"112237","DOI":"10.1016\/j.injury.2025.112237","article-title":"Intraoperative assessment of syndesmotic instability: What technique minimizes surgeon error?","volume":"56","author":"Rushing","year":"2025","journal-title":"Injury"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3113\/FAI-2009-0419","article-title":"Direct visualization for syndesmotic stabilization of ankle fractures","volume":"30","author":"Miller","year":"2009","journal-title":"Foot Ankle Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:53:58Z","timestamp":1786445638000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":56,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166217"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166217","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}