Arthroscopic Repair of Acute Proximal Detachment of the Medial Collateral Ligament in a Complex Ankle Sprain

Management of ankle sprains is still being discussed. Repair of the deltoid ligaments is suggested in patients with medial ankle instability after a ligamentous injury or malleolar fracture fixation. The purpose of this technical note is to describe an arthroscopic technique for acute repair of proximal detachment of medial collateral ligament of the ankle. With the patient in supine position under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The standard anteromedial and anterolateral portals are used. An accessory portal, inferior to the medial malleolus, is simulated with a needle under arthroscopic control. The tip of the medial malleolus is debrided, and a soft anchor is impacted there. A Lasso loop is passed twice to the medial collateral ligament to improve the grasp and to perform a U-shaped stitch. The ligament is pressed against the anchor, with the foot in maximum dorsiflexion. The arthroscopic acute repair for proximal disinsertion of medial collateral ligament ankle appears to be a reliable and reproducible technique.