Repair of the deltoid ligaments is suggested in patients with medial ankle instability after a ligamentous injury or lateral malleolar fracture fixation. Arthroscopy can be a definitive mode of determining whether there is medial instability and, therefore, help to determine whether there is a need to repair the deltoid ligaments. The authors describe a technique for the arthroscopic repair of the deltoid ligaments, using a suture passer and suture anchors. Cadaveric analysis was utilized to establish safe zones and indicate that there is a relatively wide safe zone between the posterior tibialis tendon and the saphenous vein when performing the technique. The authors have performed more than 87 arthroscopic deltoid repairs, with a greater than 90% satisfaction rate among patients. However, future studies with validated outcome measures are needed. Level of Evidence: Level V, expert opinion.

The evolution of minimally invasive surgery has led to techniques that can achieve comparable results to that of traditional open methods of surgery. For hallux valgus correction of the foot, several studies have demonstrated the equivalency between open procedures and current minimally invasive procedures in terms of stability and final outcomes. The authors present a detailed technique for minimally invasive hallux valgus correction. Early clinical and radiographic outcomes are reported, including a comparison of chevron and transverse osteotomies.Level of Evidence: Diagnostic level IV, case series. See Instructions for Authors for a complete description of levels of evidence.

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol. Methods: Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores. Results: Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (p<2.2e-16), average FAAM ADL scores rose from 69.44 to 93.09, (p<2.2e-16), average FAAM Sports scores rose from 49.76 to 89.61. (p<2.2e-16), average Ankle ROM scores decreased from 56.12o to 54.76o, (p=.001523) and average HF ROM decreased from 20.07o to 18.19o (p=1.225e-11). The average Tegner score postoperatively was 7.45 (4-10). Patients reported 75% excellent, 24% good, and 1% fair results. Average time to desired level of activity was 5.14 months. There were 5 complications: one wound dehiscence, 2 cases of anterolateral impingement, and two cases of superficial peroneal neuritis. There was no recurrent instability. Conclusion: The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability.