Percutaneous Lateral Ligament Reconstruction

Indications

Chronic lateral ankle instability with complaints of pain or functional problems

Indications Pitfalls

Patients with os subfibulare, osteochondral lesion, or any intraarticular pathology should be treated at same time by arthroscopic or open procedure.

Indications Controversies

Patients with insufficient ligament, high body mass index, failed previous lateral ligament repair surgery, or general laxity should be treated not by repair but by a reconstruction procedure.
Open or arthroscopic antiroll are other options.

Patients often complain about ankle pain, swelling, and instability after failed conservative treatment of ankle sprain.
Patients have a positive anterior drawer test.
Anteroposterior and lateral radiographs of the ankle are recommended to clarify concomitant pathology such as osteophytes, osteochondral lesions, osteoarthritis, os subfibulare, and so on ( Fig. 63.1 ).
Magnetic resonance imaging is recommended to diagnose the anterior talofibular ligament (ATFL) and calcaneofibular (CFL) rupture and concomitant pathology such as osteochondral lesions, tendinitis, synovitis, and so on ( Fig. 63.2 ).

Treatment Options

The fibular origin of the ATFL and CFL is on the inferior part of the anterior border of the distal fibula, and they have a single confluent footprint. The center of the footprint is located around 10–14 mm and 5–8 mm from the tip of the fibula, respectively ( Fig. 63.3 ).
The talar insertion of the ATFL is on the talar body, just anterior to the lateral articular surface (see Fig. 63.3 ).
The calcaneal insertion of the CFL is located on the lateral cortex of the calcaneus.

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