Zhang L, Xiong JX, Zhou X, et al. - In view of the significance of adequate reduction and stabilization of the syndesmosis for prevention of early degeneration of the ankle joint and getting better clinical outcomes, researchers herein developed a novel double Endobutton fixation to treat the distal tibiofibular syndesmotic injuries. In addition, they compared the biomechanical property of the novel double Endobutton fixation vs the intact syndesmosis, the screw fixation and the Tightrope fixation. This is the first study involving the biomechanical comparison of three fixations for the treatment of tibiofibular syndesmosis injury. They performed equal random division of 24 normal fresh-frozen ankle specimens with a mean age of 42 ± 8 (range, 28-62) years into four groups: (1) the intact group, (2) the screw group, (3) the Tightrope group, (4) the Endobutton group. The personalized distal tibiofibular syndesmotic navigation modules were established using 3D printer technology with the aim to determine the accurate bone tunnel. In five ankle positions, they applied axial loading: neutral position, dorsiflexion, plantar flexion, varus and valgus. Application of rotation torque was done in two ankle rotation of the neutral position: internal and external. Outcomes revealed a better biomechanical outcome for the novel double Endobutton fixation vs other fixations. The novel double Endobutton can maintain the distal tibiofibular syndesmosis joint micro motion and make up for the deficiency of other fixation devices in clinic. Based on outcomes, they suggest considering the novel double Endobutton as the better fixation in treatment of distal tibiofibular syndesmotic injuries.