Arthroscopic Repair of Anterior Talofibular Ligament Using the Pull-Out Technique for Chronic Ankle Instability: Case Report.

Arthroscopic repair of the lateral ankle ligament using the anchor system has been increasingly reported. We treated a 39-year-old woman who suffered from pain and instability in her left ankle joint. She was diagnosed with chronic ankle instability and an osteochondral lesion of the talar dome. For this patient, arthroscopic repair of the anterior talofibular ligament (ATFL) was performed. Standard anteromedial and anterolateral portals were placed, and excision of the osteochondral fragment and microfracture were performed. Then, an accessory anterolateral (AAL) portal was placed. No. 2 nylon sutures were inserted into the ATFL remnant through the AAL portal. Two bone tunnels were created at the footprint of the fibula attachment toward the posterior edge of the lateral malleolus using a passing pin, and nylon sutures anchored in the ATFL were retrieved toward the posterior fibula. The foot was held in neutral position with eversion, and nylon sutures were tied at the posterior fibula. At 1 year after surgery, the Japanese Society for Surgery of the Foot scale was improved from the preoperative value of 48 points to a postoperative value of 100 points. Stress radiography showed no difference of talar tilt angle between the involved and noninvolved ankles. Joint position sense was also improved at 3 and 6 months after surgery. This arthroscopic repair of the ATFL using the pull-out technique enabled achievement of an improved clinical score and stability of the ankle and proprioception, and there was no concern about complications of the anchor system.