Over the past few years, several studies have demonstrated favorable clinical outcomes and low complication rates using the ankle Tightrope® syndesmosis fixation system. The traditional surgical procedure of screw fixation for syndesmosis injury is associated with high complication rates of loosening, screw fracture, non-anatomic fixation, and post-operative syndesmotic diastasis. It is expected that the Tightrope® technique will become more common practice given the recent successful reports. Thus it is important for radiologists to be aware of this novel surgical technique and its imaging appearance.