Arthroscopic Assisted, Lateral Ligament Reconstruction with Suture Tape Augmentation and Knotless All Suture Anchors: A Technique Guide

Abstract

More than 30,000 ankle sprains occur each day in the United States, and the majority of ankle sprains involve the anterior talofibular ligament. Up to 30% of patients develop functional ankle instability and chronic pain after a severe ankle sprain. When nonoperative measures are unsuccessful, operative reconstruction of the lateral ankle ligaments is recommended. To further strengthen the repair, accelerate rehabilitation, and allow for a quicker return to sport, augmentation with suture tape has recently become an alternative among surgeons in the reconstruction of the lateral ankle ligaments. Moreover, the advent of knotless all-suture anchors decreases the number of knots required in the procedure and, in theory, reduces lateral soft tissue irritation and accentuates recovery after surgery. Here we present our technique for arthroscopic assisted, lateral ligament reconstruction with suture tape augmentation and knotless all suture anchors.

Fig 1

Arthroscopic view from the lateral portal, patient's right side. There is an avulsion of the anterior talofibular ligament (ATFL) off the distal fibula (star). (B) demonstrates positive talar tilt and associated osteochondral lesion of the medial talus (C). In each photo, the horizontal arrow marks the tibia, and the vertical arrow marks the talus. For further orientation, the vertical arrow is located on the medial side of the photo.

Fig 2

Clinical image of the lateral approach demonstrating elevation of the periosteum, anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) cuff (A). In these photos, the superior aspect of the wound is on the left side. The suture-tape is anchored in the talus and then passed through the ATFL in B and C. The periosteal cuff, ATFL and CFL are indicated with a star in (B).

Fig 3

Clinical image marking the anatomic footprint and location of the implants on the distal fibula. The patient is in the supine position and superior is to the left side of the image. The calcaneofibular ligament (CFL) is reattached at 6 mm from the tip of the distal fibula, the internal brace at 12 mm, and the anterior talofibular ligament (ATFL) at 18 mm (A). Drilling for the anchor (B), and placement of the knotless all-suture anchor (C) are then demonstrated.

Fig 4

The patient is in the supine position and superior is to the left side of the image. The knotless suture is passed through the anterior talofibular ligament (ATFL), indicated by a star (A). The suture is shuttled through the locking mechanism (B). In line traction is pulled allowing tapered tension across the repaired capsule indicated by a star (C).

Fig 5

The patient is in the supine position and superior is located on the left side of the image. The suture-tape is loaded onto the corresponding anchor, measured (A), and secured into the fibula (B). An absorbable suture is used to repair the periosteum and inferior extensor retinaculum (C).