Complete Syndesmosis Reconstruction Made Easy

Syndesmosis injuries can lead to chronic instability if not properly addressed. Current reconstruction techniques demand multiple tunnels and most do not address all the injured ligaments. The authors present a novel technique for the reconstruction of all the syndesmotic ligament complex using a tendon graft, designed to simplify the surgical approach while ensuring reproducibility and adequate tensioning of the construct. In this technique, a tendon graft is prepared to replicate the native anatomy of the syndesmotic ligaments. The graft is passed through precisely located bone tunnels in the distal tibia and fibula, mimicking the course of the AITFL, PITFL, and IOL. The graft is secured using interference screws in the posterolateral and anterolateral tibia, and an additional fixation with a suture button to replicate the interosseous ligament. The key innovations in this procedure are the simplicity of the technique and the ability to tension the repair as desired. These features can reduce operative time and increase the accuracy of ligament reconstruction. Level of Evidence: Level 5.