Background <p>The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization, for example in length-unstable syndesmotic injuries. The aim of this biomechanical study was to investigate whether a novel screw-suture implant addresses such issues compared to suture-button implants while preserving dynamic capabilities.</p> Methods <p>Eight pairs of human cadaveric lower legs were injured by complete syndesmosis and deltoid ligaments cuts, and reconstructed using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implant for syndesmotic stabilization, placed 20&#xa0;mm proximal to the tibia plafond. Following, all specimens were biomechanically tested over 5000 cycles under combined 1400&#xa0;N axial and ± 15° torsional loading. Anteroposterior, axial/vertical, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via optical motion tracking.</p> Results <p>Anteroposterior and axial/vertical movements were significantly smaller and maintained over the cycles in Group 1 compared with Group 2 (<i>p</i> &lt; 0.001). No further significant differences were identified between the groups (<i>p</i> ≥ 0.318).</p> Conclusion <p>Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw-suture reconstruction provides better anteroposterior and axial/vertical stability of the distal tibiofibular joint, and maintains it over time under dynamic loading in a cadaveric study design. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions with length-unstable fibula.</p> Level of evidence/ study design <p>Level V, Controlled Laboratory Study.</p>