Pang EQ, et al. - The contact mechanics of the tibiotalar joint following syndesmosis fixation with screws vs a flexible fixation device for complete syndesmotic injury were addressed. Researchers performed dissection of six matched pairs of cadaveric below knee specimens and fixation of motion capture trackers to the tibia, fibula, and talus and placed a pressure sensor in the tibiotalar joint. First, they tested each specimen intact with axial compressive load followed by external rotation while maintaining axial compression. Next, they sectioned syndesmotic ligaments and assigned these randomly to repair with either two TightRopes or two 3.5 mm cortical screws and the protocol was repeated. Outcome analysis suggest adequacy of both screws and TightRope fixation with AL alone. With lower amounts of torque, the TightRope group seemed to have contact and pressure mechanics that more nearly match native mechanics.