Background: Syndesmotic injury of ankle is relatively uncommon and commonly missed injury. Failure to stabilise this injury results in early arthritis. Traditionally it is being treated with screw but now tightrope is a biomechanically stable alternative. Case Report: A 60 year old female presented with ankle fracture associated with syndesmotic injury. She was operated for ankle fracture and simultaneously tightrope was used to stabilise the syndesmosis. She was allowed weight bearing mobilisation and didn’t experience implant related symptoms. Conclusion: Syndesmotic tightrope is an ideal alternative for syndesmotic screw used to stabilise these injury, as it offers early weight bearing mobilisation, anatomical reduction and avoiding second surgery for screw removal.