Lateral ankle ligament reconstruction using free split peroneal brevis tendon and fibula bone pegs: A case report

Ankle sprain is a frequent soft-tissue injury; however, chronic pain sometimes persists, requiring surgery. Tenodesis repair using free tendon graft provides satisfactory outcomes in cases where no viable ligament structure is available. However, rupture of the graft tendon can occur postoperatively, causing recurrent ankle instability. We report a case of lateral ligament reconstruction using fibula bone pegs to enhance the graft tendon fixation strength for a chronic calcaneofibular ligament injury.

A 44-year-old male presented with right ankle pain that had persisted since a fall one year earlier. Magnetic resonance imaging revealed a rupture of the right calcaneofibular ligament. Conservative treatment failed to improve pain, necessitating surgery. We made a curvilinear incision over the lateral ankle and harvested the anterior half of the peroneus brevis tendon. A bone tunnels of the fibula and the calcaneus was created, and the graft tendon was passed through it. Two bone pegs were harvested from the distal fibula, and inserted into the bone tunnel to fix the graft tendon. Postoperatively, ankle pain improved without any complications.

Lateral ligament reconstruction using fibula bone pegs provided satisfactory short-term outcomes. The use of fibula pegs, rather than special synthetic implants, allows for secure fixation of the tendon using the patient's own bone and eliminates the risk of foreign body reactions.

This report presents a new fixation procedure on the lateral ankle ligament reconstruction using free graft tendon, which can improve physiological fixation strength of the graft tendon.