A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle "giving way" with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broströ m) are preferred to nonanatomic procedures since they recreate the ankle's biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.

Purpose Tendon grafts are often utilized for reconstruction of the lateral ligaments unamenable to primary repair. However, tendon and ligaments have different biological roles. The anterior tibiofibular ligament's (ATiFL) distal fascicle may be resected without compromising the stability of the ankle joint. The aim of this study is to describe an all‐arthroscopic and intra‐articular surgical technique of ATiFL's distal fascicle transfer for the treatment of chronic ankle instability. Methods Five unpaired cadaver ankles underwent arthroscopic ATiFL's distal fascicle transfer using a non‐absorbable suture and a knotless anchor. Injured or absent ATiFL's distal fascicle were excluded from the study. Following arthroscopy, the ankles were dissected and evaluated for entrapment of nearby adjacent anatomical structures. The ligament transfer was also assessed. The distance between the anterolateral (AL) portals and the superficial peroneal nerve (SPN) was measured and the shortest distance was reported. Results All specimens revealed successful transfer of the tibial origin of the ATiFL's distal fascicle onto the talar insertion of anterior talofibular ligament's (ATFL) superior fascicle. The fibular origin of the ATiFL's distal fascicle remained intact. There were no specimens with SPN or extensor tendon entrapment. The median distance between the proximal AL portal and SPN was 3.8 mm. The median distance between the distal AL portal and SPN was 3.9 mm. Conclusion An all‐arthroscopic approach to an ATiFL's distal fascicle transfer is a reliable method to reconstruct the ATFL's superior fascicle. Transfer of ATiFL's distal fascicle avoids the need for tendon harvest or allograft. The lack of injury to nearby adjacent structures suggests that it is a safe procedure. The clinical relevance of the study is that ATiFL's distal fascicle can be arthroscopically transferred to be used as a biological reinforcement of the ATFL repair, or as an ATFL reconstruction.

AIM:To compare functional outcomes and adverse events of surgically treated syndesmotic injuries with either screw(s) or suturebutton(s). It was hypothesized that suture-button fixation would provide equal clinical results with fewer adverse events. MATERIALS AND METHODS: Multi-center, randomized clinical study. Sixty-five subjects with confirmed acute syndesmotic injury requiring surgical intervention were enrolled. Subjects were randomized and treated with either suture-button or screw fixation. Foot and Function Index pain, disability, and activity scores, American Orthopaedic Foot and Ankle Society scores, and the Visual Analogue Scale for pain were reported up to 12-months. The adverse events were also collected. The forty subjects with complete data up to one year (n = 40; suture-button = 18 and screw = 22) were included in analysis. Single or multiple screws or suture-button implants were based on surgeon preference and patients' characteristics. RESULTS: There was statistically significant improvement in Foot and Function Index and American Orthopaedic Foot and Ankle Society scores with both techniques (p < 0.05). Visual Analog Scale scores improved significantly with the screw technique (p < 0.05) but not with the suture button technique. CONCLUSION: One-year clinical data suggests that acute syndesmotic injuries can be effectively treated with either technique. A possible benefit of suture button fixation may be a lower occurrence of adverse clinical events.

The treatment of osteochondral lesions of the talus (OLTs) can be challenging. Currently, there exists a wide variety of treatment options to address OLTs, and the development of new, innovative surgical techniques has continued to evolve. The use of extracellular matrix cartilage allografts, or BioCartilage, is a biological agent that can be utilized as an adjunct to bone marrow stimulation. There are early promising clinical, radiographic, and histologic results. Therefore, it is prudent to understand the application of extracellular matrix cartilage allograft in the treatment of OLTs. We will provide a detailed review of the surgical technique and postoperative management, as well as guidelines for the indications for the procedure.

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