Syndesmotic malreduction rate following an acute ankle syndesmosis rupture fixation vary widely between studies depending on the imaging modality chosen and the criteria used. The purpose of this study is to compare the rate of syndesmosis malreduction in patients surgically treated for an acute unstable syndesmosis rupture with either a 3.5mm quadricortical metallic screw or a suture-button device (Tightrope®, Arthrex, Naples, FL).