Techniques of Arthroscopic Anterior Syndesmosis Stabilization

Ankle sprains are among the most common sports-related musculoskeletal injuries. Injury to the anterior inferior tibiofibular ligament, resulting in anterior syndesmotic instability, is frequently overlooked and inadequately treated. The purpose of this technical note is to (1) describe clinical examination maneuvers used to assess anterior syndesmotic stability; (2) review radiologic features suggestive of syndesmotic instability; and (3) present 2 arthroscopically assisted techniques for anterior inferior tibiofibular ligament reconstruction. The surgical techniques are described stepwise, with emphasis on indications, technical pearls, and potential pitfalls.