62 patients with either an isolated injury or concomitant injury of the syndesmosis to an ankle fracture were randomized to stabilization of the syndesmosis with either a knotless suture button device (TightRope; Arthrex) or a single, 3.5mm screw. A total of 54 patients were analyzed for follow-up. Patients were assessed over the first 12 months after surgery for patient-reported functional scores, pain scores, time to return to sports activities and work, and the incidence of complications. Apart from a transient significant difference in Olerud-Molander score at 7 weeks, the only other significant difference in efficacy noted between groups was time to return to sports activities, which was significantly shorter in the knotless suture button group.