Lateral Ankle Ligament Injuries in Athletes: Diagnosis and Treatment

Anterior drawer. (A) Allow the leg to hang freely with the foot plantar flexed to 25°. Stabilize the tibia with 1 hand and grasp the heel with the other. Pull the foot anteriorly while allowing it to rotate internally as it translates. Excessive anterior translation will be detected with an incompetent anterior talofibular ligament (ATFL). (B) A dimple or suction sign may be visible over the anterolateral corner of the joint.

Recognition of associated hind foot varus is critical to the success of lateral ankle ligament reconstruction.

Incisions for lateral ankle ligament reconstruction. (A) modified Broström; (B) peroneal tendon exploration or anatomical allograft reconstruction; (C) Dwyer calcaneal osteomy.

The intermediate branch of the superficial peroneal nerve may approach the surgical field.

Periosteal flap augmentation of the Broström lateral ligament reconstruction. (A) Release the ATFL and calcaneal-fibular ligament (CFL) origins from the distal fibula leaving a small cuff of tissue; (B) examine the lateral joint if indicated; (C) elevate the distal fibular periosteal flap, and (D) reflect posteriorly and distally; (E) after creating a trough in the distal fibula make 3 drill holes; (F) pass suture through drill holes and grasp the ATFL and CFL capsuloligamentous complex; (G) after securing the ligaments, overlay and secure the periosteal flap.

Anatomical lateral ligament reconstruction with semitendonosus allograft. (A) Divide the ATFL and CFL as previously described and expose the talar neck; (B) drill bone tunnels in the distal fibula and talar neck, then pass the all graft tendon through the distal fibula; (C) then route the tendon through the talar neck, and (D) return the free end through the same fibular tunnel; (E, F) secure the allograft with suture as it passes through the fibular tunnel; (G, H) and then tension and secure the remaining free ends at the insertion of the CFL.