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, nonanatomic fixation, and postoperative syndesmotic diastasis. It is expected that the Tightrope® technique will become more common practice given the recent successful reports, so it is important for radiologists to be aware of this novel surgical technique and its imaging appearance.