Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials

James Randolph Onggo, Mithun Nambiar, Kevin Phan, Benjamin Hickey, Anuruthran Ambikaipalan, Raphael Hau, Harvinder Bedi

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)


Background: Ankle syndesmotic injuries can be surgically managed with syndesmosis screws (SS) or suture button (SB) fixation. We performed a meta-analysis of randomized controlled trials (RCTs) aiming to compare the clinical and complication profiles of both modalities. Methods: A multi-database search up to 4th of March 2018 was performed according to PRISMA guidelines. All RCTs comparing both techniques and published in English were included. Results: Five RCTs with a total of 280 patients (140 SB, 140 SS) were included for analysis. SB had a statistically significant higher AOFAS score at 1 year (mean difference = 5.46, 95% CI = 0.40–10.51, p = 0.03) and lower implant failure rate (OR = 0.03, 95% CI = 0.01–0.15, p < 0.001). Infection and wound issues were marginally higher with SB (OR = 1.4, 95% CI = 0.4–4.85, p = 0.60). No other parameters showed statistically significant difference. Conclusions: Both constructs yielded similar clinical outcomes. The 1 year AOFAS score was higher in SB but clinical significance is unlikely. SB had significantly fewer implant failures. Level of evidence: Level I.

Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalFoot and Ankle Surgery
Issue number1
Publication statusPublished - 1 Jan 2020


  • Ankle
  • Diastasis
  • Screw
  • Suture button
  • Syndesmosis

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