BACKGROUND Acute injuries to the tibiofibular syndesmosis, often associated with high ankle sprains or malleolar fractures, require precise diagnosis and treatment to prevent long-term complications. This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries. CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain. Due to significant swelling and poor soft tissue quality, initial management involved external stabilization. Subsequently, needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury. The procedure, performed under spinal anesthesia and fluoroscopic control, included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button. Follow-up assessments showed significant improvement in pain levels, range of motion, and functional scores. At 26 weeks post-procedure, the patient achieved full range of motion and pain-free status. Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries, combining diagnostic and therapeutic capabilities with minimal invasiveness. CONCLUSION This technique may enhance clinical outcomes and reduce recovery times, warranting further investigation and integration into clinical practice.

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. Results: Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula–tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. Conclusions: The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated.

Syndesmotic malreduction remains a major contributor to poor outcomes after ankle injuries, yet conventional fixation methods rely primarily on fluoroscopic assessment and may not fully reveal rotational or subtle translational malalignment. Needle arthroscopy offers direct visualization of the distal tibiofibular interval, enabling precise assessment of the injury and real‐time confirmation of reduction. This surgical technique describes a fully arthroscopic approach to anatomic reduction and dynamic stabilization of the syndesmosis using a suture button device. After arthroscopic identification of the pathological widening, a four‐cortex trans‐syndesmotic tunnel is created under fluoroscopic control, the medial button is deployed, and final reduction is achieved through symmetric tensioning while monitoring the syndesmosis with needle arthroscopy. This method allows accurate restoration of the fibular position within the incisura with minimal soft‐tissue disruption and may reduce the risk of malreduction associated with traditional techniques.

Background: Needle arthroscopy can alter not only portal size but also the diagnostic and treatment pathway by enabling direct visualization under local anesthesia and selected limited interventions. Its diffusion across joints, however, may be outpacing clinical validation. Methods: This PRISMA-ScR-guided review mapped PubMed/MEDLINE-indexed primary publications from database inception through 31 July 2026. The quantitative flow is therefore an auditable but incomplete evidence map rather than a complete census of the technology; studies indexed exclusively outside PubMed may have been missed. Backward reference-list screening was used as a completeness check, while earlier Scopus, Web of Science, and Cochrane histories were retained as sensitivity sources and not pooled into the quantitative flow. Two reviewers independently screened and charted records using a shared form. Reports were de-duplicated by PMID, DOI, and normalized title and characterized by anatomy, design, application, platform, outcomes, harms reporting, study-design hierarchy, and principal methodological limitation. Technical or cadaveric feasibility was analyzed separately from clinical and comparative evidence. Results: The final map comprised 105 unique primary publications: 49 technical, 41 clinical, and 15 cadaveric. Technical and cadaveric reports (64/105, 61.0%) outnumbered clinical reports (41/105, 39.0%), limiting estimation of clinical effectiveness. Ninety publications (85.7%) appeared from 2021 onward; the 2026 count is incomplete because the search ended on 31 July. For descriptive display across the complete map, nine reports (8.6%) were in Levels I–II and 93 (88.6%) in IV–V; among the 41 clinical reports, 29 (70.7%) were IV–V and 12 (29.3%) were I–III. NanoScope accounted for 87 of 107 platform mentions (81.3%). Diagnostic and second-look applications had the most consistent comparative rationale, but lesion-specific estimates varied by joint and reference standard. Reported harms were generally minor where surveillance was described, but rare-harm inference was limited by small samples and inconsistent adverse-event ascertainment. Conclusions: The field remains promising but unproven: technical breadth exceeds comparative clinical validation. Because the quantitative evidence map is PubMed/MEDLINE-only and dominated by technical, cadaveric, and IV–V reports, current evidence is insufficient to estimate clinical effectiveness or justify replacement of MRI or conventional arthroscopy. Needle arthroscopy should therefore be viewed as an indication-specific complement and a hypothesis-generating technology rather than a replacement platform. Multicentre comparative studies and randomized trials, where ethically and practically feasible, are needed to test patient benefit and clinical application.