Surgical Procedure
Curved incision crossing the tip of the lateral malleolus
Dissect towards the extensor digitorum muscle
With the ankle in dorsiflexion, incise the fascia to disclose the muscle belly
Create arthrotomy by removing a part of the joint capsule
Open the sheet of the peroneal tendons distal to the tip of the lateral malleolus
Overview
Release the Anterior Talofibular ligament and Calcaneofibular ligament
Reconstruction is performed with Bunnell sutures
Posterior incision, proximal to the peroneal tendon retinaculum
Create a raw bone surface of the anterior fibula tip
Drill 2 2.5 mm holes in the fibula tip. Preserve a bony bridge between the holes
Pull the sutures through, using the suture passer. Knot the sutures with the foot in everted position
Pull the ligament remnants tight over the denuded fibula tip to secure the reconstruction. A tight reconstruction has been achieved
Pearls & Pitfalls
1. Use resorbable sutures. The time to resorption of the sutures is long enough to heal the reconstruction. In addition, unresorbable sutures can cause irritation.
2. Tighten the sutures with the foot in eversion. Since it is an anatomical reconstruction, it can never be too tight.
3. Laxity can remain when the sutures are initially knotted at the posterior tip of the fibula. To secure a tight reconstruction, pull the ligament remnants tight over the denuded fibula tip (picture)
4. Pull the ligament remnants tight over the denuded fibula tip to secure the reconstruction. A tight reconstruction has been achieved