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

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–Molander 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 ± 3.8 to 86.4 ± 5.6, whereas the mean VAS score decreased from 8.1 ± 0.7 to 0.3 ± 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.