Chronic Ankle Sprains (Medial Ankle Instability): Ligament Repair With Suture Augmentation Procedure

Chronic Ankle Sprains (Medial Ankle Instability): Ligament Repair With Suture Augmentation Procedure

This surgical video demonstrates a repair of the deltoid ligament of the ankle with a suture augmentation technique to treat medial ankle instability. Here, we see a left ankle with the inner side of the ankle facing the screen. The surgeon has already marked out where the incision will be made along the ankle with a purple skin marker.

The surgeon begins by cutting through the skin and soft tissue at the inner side of the ankle to access the deltoid ligament. At this time, the surgeon will use their desired technique to repair the deltoid ligament. This video only shows the surgeon adding the support suture.

The surgeon then uses a drill to make a socket into the inner ankle bone, called the medial malleolus, and uses an instrument, called a tap, to widen the socket. The surgeon inserts a hard-body anchor into the socket and taps it into the bone. The anchor has sutures already in place, which include 2 strands of flat support suture. These strands will be connected to 2 different bones in the foot and ankle to provide additional support for 2 different parts of the deltoid ligament.

The surgeon next moves below to the inner side of the heel bone, called the calcaneus. Once the correct area is identified, the surgeon drills a metal pin into the heel bone and uses a tap to prepare another socket. The surgeon passes the end of 1 of the flat support suture strands through a guide wire, which is used to thread it through the tip of a hard-body anchor. While applying tension, the surgeon positions the anchor over the suture and taps the anchor into the socket in the heel bone. This tacks down the flat support suture to hold it in place. The surgeon then cuts off the rest of the strand.

Next, the surgeon moves soft tissue out of the way to access the talus bone of the ankle and repeats the same steps. The surgeon drills a socket into the talus and uses a tap to widen the socket. The surgeon passes the end of the other flat support suture strand through a guide wire to thread it through the tip of another anchor, positions the anchor over the suture, and taps it into the socket in the talus. The surgeon then cuts off the flat support suture and will close the skin incision with regular sutures. The deltoid ligament repair with suture augmentation is complete.