Tightrope surgery is a technique used to stabilize the ankle after an injury, specifically a high ankle sprain or a fracture of the fibula. It is also used to repair a syndesmotic injury, which is when the syndesmotic ligaments between the tibia and fibula are damaged, causing the bones to separate. The TightRope system, developed by Arthrex, is used to anchor the ends of the tibia and fibula together with a braided polyethylene cord, rather than with a rigid surgical screw, to restore the original position of the bones and to allow for proper healing. The TightRope system allows for flexible fixation, which is an improvement over the previously rigid forms of fixation. This means that there is no need for a second surgery to remove the screws, which would have been required with previous methods. The TightRope system is used to stabilize the syndesmosis in a flexible manner, keeping the natural motion between the tibia and fibula, and allowing for faster rehabilitation. A patient with a syndesmotic injury should be evaluated by an orthopedic foot and ankle surgeon, who will perform a patient history, a physical exam with stress testing of the syndesmosis, and weight-bearing x-rays. Sometimes more advanced imaging such as a CT scan or an MRI is needed.