97 patients with an acute syndesmotic injury were randomized to surgical stabilization with either a suture button device or a syndesmotic screw. Patients were followed-up for results on function, pain, and radiological outcome over a 2-year follow-up. Results demonstrated that the suture button device was significantly favoured over a syndesmotic screw for functional outcome from 6 months to 2 years, for dynamic pain scores from 1 year to 2 years, and the rate of malreduction (ie. loss of reduction in tibiofibular distance) in the anterior and central areas of the syndesmosis within 1 year of surgery.