The distal tibiofibular syndesmosis is a ligamentous complex that plays a vital role in the stability of the ankle joint. Injuries to the syndesmosis are relatively common and occur when the foot is externally rotated relative to the tibia and fibula. Severe syndesmotic injuries are treated surgically, and typically involve reduction with internal fixation using screws or suture endobutton devices. Unrecognized syndesmotic injuries or failed syndesmotic fixation can lead to chronic syndesmotic injuries. The treatment of chronic syndesmotic injuries is controversial, though commonly performed procedures may involve ORIF, reconstruction, or arthrodesis. In this video we present a pediatric patient who sustained a chronic syndesmotic injury after two previous failed surgical procedures and includes diagnosis, treatment consideration and decision making, and our surgical technique in the reconstruction of her syndesmosis using semitendinosus allograft.