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. 2023 Aug 30;11(10):344.
doi: 10.21037/atm-23-1527. Epub 2023 Jun 28.

Biomechanical profile of varying suture button constructs in cadaveric specimens: a systematic review and meta-analysis

Colleen M Wixted  1 , Emily J Luo  1 , Taylor P Stauffer  1 , Kevin A Wu  1 , Samuel B Adams  2 , Albert T Anastasio  2
Affiliations

Biomechanical profile of varying suture button constructs in cadaveric specimens: a systematic review and meta-analysis

Colleen M Wixted et al. Ann Transl Med. .

Abstract

Background: Suture button fixation of syndesmotic injuries allows for more physiologic motion of the ankle joint while maintaining adequate reduction and may avoid the need for additional surgeries, given the lower risk of syndesmotic diastasis and implant failure. Few studies have examined the optimal number and configuration of suture buttons for syndesmotic disruption. The purpose of this systematic review and meta-analysis is to compare different suture button configurations from the cadaveric literature and to assess their relative effect on the stability of the syndesmotic reduction and functional movement of the ankle.

Methods: A literature search in the databases MEDLINE via PubMed, Embase via Elsevier, Scopus via Elsevier, and SPORTDiscus via EBSCO were searched through December 2022 to identify studies related to cadaveric modeling of the syndesmosis. Only cadaveric studies with suture button fixation and studies in English were included. The quality of cadaveric studies was assessed using the Quality Assessment for Cadaveric Studies (QUACS) tool. Revman 5.3 software was used to perform the meta-analysis.

Results: The meta-analysis included 5 studies and 86 limbs. The systematic review included 15 studies. When comparing single and double suture button configurations, no difference was found between groups with regard to fibular rotation (MD =-0.9; 95% CI: -2.09 to 0.27; I2=79%; P=0.13) and both groups had similar rotational stability. The double suture button technique did demonstrate less sagittal fibular translation compared to the single suture button (MD =0.48; 95% CI: 0.02-0.94; I2=66%; P=0.04). When comparing two suture buttons in parallel and divergent configurations, studies did not find any differences with regard to strength or stability.

Conclusions: There were no significant differences in biomechanical parameters when comparing single and double suture button constructs. While single button suture constructs result in minimal fibular rotation, double suture button constructs minimize fibular translation. This review may serve as a guide for clinicians when approaching these injuries.

Keywords: Syndesmosis injury; cadaveric studies; screw fixation; suture button constructs; suture button fixation.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-1527/coif). The series “Foot and Ankle Surgery” was commissioned by the editorial office without any funding or sponsorship. ATA served as the unpaid Guest Editor of the series. SBA reports consulting fees from Coventus/Flower, Stryker, DJO, Orthofix, Inc, Regeneration Technologies, served as a Board or Committee member for AOFAS, and holds stock or stock options of Medshape. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagram of study screening process.
Figure 2
Figure 2
Forest plots for fibular rotation in single suture button vs. double suture button (inverse variance and random effects model).
Figure 3
Figure 3
Forest plots for fibular translation (sagittal plane) in single button suture vs. double button suture (inverse variance and random effects model).
See this image and copyright information in PMC

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