Abstract: [Abstract] ObjectiveTo investigate the clinical efficacy of suture-fixationfor the old injury of distal tibiofibular syndesmosis treated with Knotless TightRope.Methods52 consecutive patients undergoing surgery were divided into experimental and control groups.The experimental group was treated by Knotless TightRope, Control group was treated with 4.5mm screws. Postoperative complications, motion range of ankle-joint,VAS score, AOFAS score, SF-36 scores were recorded.Result Average follow-up period of 52 patients is 22.3 months. All scores have no significant difference after 6 months follow-up, but there is statistical difference in 22 months. All cases healed without infection. In experimental group,no re-seperation was observed.In control group,distal tibiofibular syndesmosis seperated in 5 patients after fixation breakage.ConclusionKnotless TightRopehas definite clinical effect to for the old injury of distal tibiofibularsyndesmosis.Reliable fixation has the advantages of early exercise with full weight bearing.