Suture Button Versus Screw Fixation for Syndesmosis Injuries: A systematic Review and Meta-analysis .

Suture button fixation has become an increasingly common alternative to syndesmotic screws, and evidence from seven RCTs helps clarify how these options compare. Across studies, short-term outcomes favour the suture button, with patients reporting less pain and slightly better early AOFAS scores. Reoperation rates were also lower, suggesting a safety advantage. Other outcomes—OMA scores, EQ-5D, loss of reduction, and longer-term follow-up—showed no meaningful difference, though most of this evidence is low to very low certainty. Variation in screw type, fixation technique, and small sample sizes limits confidence in long-term comparative effectiveness. More high-quality RCTs and cost-effectiveness analyses are needed to guide implant selection and balance clinical benefit with financial responsibility.