Table 2.

Characteristics of clinical studies

Study	n	Outcome	Method	Conclusion	Level of evidence
Cottom et al. [7]	50 25 Tightrope 25 screw	AOFAS, SF12	Single tightrope/double tightrope versus screw fixation	AOFAS and SF12 no significant difference between screw and tightrope, 6 months postoperatively	II
Thornes et al. [38]	32 16 screw 16 flexible fixation	AOFAS	4 cortices syndesmotic screw fixation versus suture-button fixation	AOFAS was significantly better in the suture-button group after 3 months and 1 year	III
Cottom et al. [6]	25	AOFAS, SF 12	Single tightrope/double tightrope	Method quick to perform. No complications, early weight-bearing, early return to daily living, sports and work	IV
Willmott et al. [42]	6	Radiological evaluation	5 single and one double tightrope	2/6 removed. One because tender swelling over button	IV
Thornes et al. [38]	12	AOFAS	Single tightrope fixation	No major complications, AOFAS mean 87 at FU at least 6 months, 8/8 returned to work in 3–16 week. Mean dorsiflexion 4.3 beyond neutral versus 8.7 contralateral	IV
de Groot et al. [8]	24	AOFAS	Single/double/triple tightrope	AOFAS 94 mean at last FU. (20 months) No major complications. 6 devices removed. 2× suture-button with subsidence Despite this no worse functional outcome	IV