All-Inside Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Anterolateral Ankle Instability Using a Knotless Suture Anchor, Allowing for Tension Adjustment

In recent years, arthroscopic anterior talofibular ligament (ATFL) repair techniques have been increasingly used for chronic ankle instability. Besides permitting the treatment of several comorbidities, arthroscopic techniques are applied to minimize the need for aggressive surgery and improve the assessment of anatomic structures. We describe our surgical technique for all-arthroscopic anatomic ATFL repair using a knotless anchor, which can adjust suture tension under direct visualization using a self-locking mechanism. Thus, this technique diminishes the chance of repaired ligament separation from its attachment by obtaining the desired tension. Moreover, its knotless property allows the avoidance of some complications such as neuritis and pain related to bulky knots.
Technique Video Video 1 Arthroscopic demonstration and illustration of arthroscopic anterior talofibular ligament (ATFL) repair. A medial midline portal and an accessory anterolateral portal are used as a viewing portal and working portal, respectively. A Micro SutureLasso (TFCC, Short 70° bend, Arthrex and knotless SutureTak anchor (3.0 12.7 mm; Arthrex) are used for ATFL repair.