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Background To compare biomechanically metal screw fixation to suture-button or bioabsorbable screw fixation for ankle syndesmotic injuries. Methods A literature search of the comparison studies in Pubmed and Google Scholar was conducted. The biomechanical outcomes of interest were syndesmotic stability in the coronal, sagittal, and axial planes as well as torque and rotation at failure. Results A total of 11 cadaveric studies were included. In the suture-button group, coronal displacement (MD 1.72mm, p = 0.02) and sagittal displacement