Using Fibularis Tertius Tendon for V-Shaped Double-Bundle Anatomic Anterior Talofibular Ligament Reconstruction

Multiple autografts have been employed in reconstructing anterior talofibular ligament (ATFL) in patients with chronic lateral ankle instability. However, conventional techniques using peroneal tendons longus/brevis as graft sources carry inherent risks of donor site morbidity. This Technical Note describes using the fibularis tertius tendon for V-shaped double-bundle anatomic ATFL reconstruction in patients with chronic lateral ankle instability. This technique restores the ATFL's multifascicular anatomy, minimizes donor morbidity through optimized graft selection, and preserves peroneal tendon integrity while maintaining traditional autograft-equivalent biomechanical strength.