Socket-Anchor Technique for 3-Portal All-Inside Arthroscopic Anterior Talofibular Ligament Reconstruction Using Allograft Tendon

Abstract

Arthroscopic techniques for anterior talofibular ligament (ATFL) reconstruction have been developed in recent years. Allograft tendons are often used in ATFL reconstruction, and surgical indications include an insufficiently strong ligament remnant, high-demand activities, repeated ankle sprains, and revision cases. We describe a socket-anchor technique for talar tunnel creation: A 10-mm-deep bone tunnel (socket) is created along a previously located guidewire at the ATFL talar footprint; an absorbable suture anchor is inserted into the end of the socket; and the graft is tied to the suture, pulled into the socket, and finally, secured using an arthroscopic knot pusher. This technique provides the advantages of being minimally invasive, ensuring a sufficient tendon-bone interface healing area of the graft, avoiding medial neurovascular bundle injury and the risk of talar neck fracture caused by screw fixation, and having no special restrictions on the direction of the anchor with blind tunnel creation. In addition, the procedure is easy to perform with high fault tolerance and no need for intraoperative fluoroscopy.