Proximal tibiofibular joint instability is a rare pathologic condition that may result in painful subluxations and neuritic symptoms from irritation of the common peroneal nerve. The incidence of proximal tibiofibular joint instability is underestimated because of spontaneous reduction and underdiagnosis but is highest in athletes who participate in sports that involve twisting or pivoting on a flexed knee. Current surgical treatment options include internal fixation, arthrodesis, fibular head resection, direct ligament repair, and ligament reconstruction with the use of a free graft; however, no consensus exists with regard to the optimal technique. This video describes stabilization of tibiofibular joint instability via cortical button suspensory device fixation, which affords joint stability and eliminates the need for free graft harvest or rigid screw fixation. The case presentation of a 15-year-old male competitive cross-country athlete with an 8-week history of lateral radiating leg pain who underwent fixation is discussed. A suspensory device was inserted through the proximal fibular and tibial cortices, using suture and tensioning handles to ensure optimal placement and tensioning of the button along the medial tibia. Partial–weight bearing was initiated 2 weeks postoperatively, and the patient successfully returned to sports activity after 4 months of physical therapy. The case presentation suggests that fixation with the use of a cortical button suspensory device allows for early rehabilitation and return to sports activity without morbidity. This video illustrates pearls and pitfalls associated with the diagnosis and surgical management of proximal tibiofibular joint instability.