Chronic instability of the distal tibiofibular syndesmosis is associated with poor functional outcomes and the development of arthritis. Stabilization of the distal tibiofibular joint after a neglected or recurrent diastasis can be accomplished using a variety of surgical procedures; however, no 1 technique has shown clear superiority. Arthrodesis is considered the most reproducible means of restoring stability at the distal tibiofibular joint; however, the limitation of motion can be associated with ankle pain and may exacerbate symptoms from early ankle degenerative disease. This article presents an algorithmic approach using a double limb allograft reconstruction for symptomatic patients with persistent radiographic widening and either subtle syndesmotic instability or significant disruption and lateral talar shift due to attenuated or disrupted syndesmotic ligaments. The technique primarily reconstructs the interosseous ligament and does not attempt to individually recreate each ligament of the syndesmosis to preserve physiological fibula rotation and translation. Early outcomes have been excellent.
Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.