Table 1.

Characteristics of mechanical studies

Study	n	Outcome	Method	Conclusion
Klitzman et al. [17]	8 fresh frozen human ankles	Syndesmotic gap Tibiofibular movement Laxity due to cycling	Cycling at submaximal loads in six-degrees-of-freedom-machine Dorsal/plantar flexion; internal/external rotation and inversion/eversion	Good alternative for syndesmotic fixation. More physiologic type of fixation and a good ability to maintain reduction in syndesmosis. No second surgery necessary
Soin et al. [35]	Ten pairs of cadaveric legs	Fibular translations and rotation	Axial compression, external rotation and combination Linear variable displacement transducer	Screws were closer to native ankle motion in AP and ML motions; Suture-button was closer to native fibular rotation
Forsythe et al. [10]	Ten fresh frozen cadaveric ankle pairs	Maintain syndesmotic reduction as compared to metallic screw	External rotation force on intact ankles and after dissecting the syndesmotic and deltoid ligaments	The fibre wire button was unable to maintain syndesmotic reduction in the ankle at any forces applied
Thornes et al. [37]	Sixteen embalmed cadaveric legs	Diastasis in suture-button versus 4 cortical screw	Generating an external rotation torque	Suture-endobutton fixation at least equals the performance of screw fixation
Miller et al. [22]	26 formalin-preserved cadaveric legs	Maximum load and displacement at failure in suture constructs and tricortical screws	Tested to failure along the axis of the repair apparatus. Screw versus suture at 2 and 5 cm above tibial plafond	Good alternative to internal fixation of ankle mortise instability due to syndesmotic rupture