Surgical techniques | Anterior arthroscopy

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Ankle arthroscopy has been used to treat patients with chronic ankle instability since 2010. A variety of procedures have been described with good results and low complication rates. All inside ATFL repair using knotless anchors is an anatomic repair with restoration of the original ligament. In cases of poor ligament tissue remnant or the absence of remnant ligament, anatomical repair is not possible. In these cases, the recommendation is to add an  augmentation or perform one of the available reconstruction procedures. Arthroscopic or Percutaneous Reconstruction techniques have been described with diferent grafts (auto or allograft) to replace the insufficient ligament. A correct precise localization of the fibula, talar and calcaneal tunels is necesary to create a near anatomic procedure.

We describe a modified “All inside” ATFL repair using two portals. The classic AM and a slighty modification of the AL portal located 5-6mm lateral to the classic AL portal.


Recommended literature

Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) Allinside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34(12):1701–1709

Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability. Batista JP, Del Vecchio JJ, Patthauer L, Ocampo M.Open Orthop J. 2017 Jul 31;11:617-632. doi: 10.2174/1874325001711010617. eCollection 2017. PMID:29081860

Takao M, Glazebrook M, Stone J, Guillo S (2015) Ankle instability group. Ankle arthroscopic reconstruction of lateral ligaments (ankle anti-ROLL). Arthrosc Tech 4(5):e595–e600

Guillo S, Archbold P, Perera A, Bauer T, Sonnery-Cottet B (2014) Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft. Arthrosc Tech 3(5):e593–e598

Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström–Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39(11):2381–2388

Pereira H, Vuurberg G, Gomes N, Oliveira JM, Ripoll PL, ReisRL, Espregueira-Mendes J, van Dijk CN (2016) Arthroscopic repair of ankle instability with all-soft knotless anchors. Arthrosc Tech 5(1):e99–e107