A stable and precise articulation of the distal tibiofibular syndesmosis is essential for normal motion of the ankle joint. Injury to the syndesmosis occurs through rupture or bony avulsion of the syndesmotic ligament complex. External rotation of the talus has been identified as the major mechanism of syndesmotic injury. None of the syndesmotic stress tests was sensitive or specific; therefore the diagnosis of syndesmotic injury should not be made based on the medical history and physical examination alone. With the improvement in ankle arthroscopic technique, it can be used as a diagnostic and therapeutic tool in the management of distal tibiofibular syndesmosis injury.

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a b s t r a c tBackground/Purposes: The outcome of tendon repair depends on the strength, which allows early active mobilization to achieve better function without rupture. The aims of this study are to assess quantitatively the biomechanical properties and relationship between the number of tendon weaving and suture method using Pulvertaft technique. Results: We found that the load to failure was increased with increasing number of weaves and sutures. From 1-weave to 4-weave single suture samples, the peak load to failure was 9.5 N, 19.7 N, 37.5 N, and 42.6 N, respectively. Based on previous studies, wrist and finger tendons should withstand 1e8 N on passive mobilization. Conclusion: On active mobilization, finger tendon repair need to provide 34 N for immediate mobilization. Therefore, irrespective of number of sutures, both 3-and 4-weave repairs could allow early mobilization biomechanically.