Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair.

A 39-year-old woman sustained a grade II open bimalleolar fracture-dislocation of the left ankle. Six months after an ORIF of these fractures was performed, she presented with a nonunion of the distal fibula fracture and with a fixed hindfoot equinovarus and forefoot adduction deformity. At surgery for repair of the fibular nonunion, the posterior tibial tendon (PTT) was found to be entrapped in the posterior tibiotalar joint, with a portion of the tendon interposed between the tibia and the fibula in the area of the posterior syndesmosis. After extrication of the PTT, the hindfoot varus and forefoot adduction deformity were corrected. To our knowledge, this is the first case report in the English literature of a missed PTT syndesmotic entrapment that resulted in a fibular nonunion and in a fixed foot deformity after an open bimalleolar ankle fracture dislocation.

The Brostrom-Gould technique for lateral ankle ligament reconstruction is a well known and widely used procedure for ankle instability. Absorbable suture anchors have been successfully used for reattachment of the ligaments to the distal fibula, allowing for fast repair. The strength of the repair depends largely on the number of anchors, their pullout strength, quality of the tissue being reattached and the surface area of ligament adherence to bone, or the footprint of the attachment. The Suture Bridge (or double row repair) technique has been successfully used in other areas of tendon repair, such as rotator cuff repair and Achilles tendon reattachment. This technique has been adopted for the lateral ankle ligament reconstruction. It provides a reliable, fast, and easily reproducible repair with strength superior to that of a single row anchor ligament reattachment that allows patients a faster return to weight bearing and normal activities. After a 2-year follow-up, 95% of patients had a satisfactory result, with the rest requiring a revision procedure with a tendon augmented reconstruction.

Second toe metatarsophalangeal joint overload produces a spectrum of deformities, starting with metatarsalgia and synovitis, progressing to plantar plate and collateral ligament attenuation and rupture, leading finally to crossover toe deformity and joint subluxation and dislocation. Successful treatment of this problem requires careful preoperative assessment and selection of surgical techniques designed to address the individual biomechanical and anatomic factors contributing to the condition. This article presents an algorithm for sequential evaluation of the pathophysiology and a stepwise approach to the surgical correction of the deformity. Frequently, several procedures need to be combined to achieve a satisfactory outcome. The author's results showed improved patient satisfaction rate and fewer complications when combined techniques were used for the correction of difficult deformities over the use of a single procedure.

A 15-year-old multisport athlete with chronic left ankle pain and instability 2 years following initial injury was diagnosed with an unstable osteochondral fracture of the lateral talar dome, osteochondritis dissecans, and lateral ligament instability. The patient underwent open surgical repair consisting of loose body excision, lateral ligament reconstruction, and talar dome debridement and microfracture followed by postoperative therapeutic exercise for 7 months. The patient successfully returned to competitive sports within a calendar year. Although not considered particularly rare among adult populations, osteochondral fracture of the talus is relatively rare in adolescents. This case demonstrates that a diagnosis of unstable osteochondral fracture and/or gross lateral ligament instability should be considered in cases involving adolescent athletes with significant ankle injury and prolonged pain and/or loss of function.