When instability persists despite an anatomic repair, many surgeons turn to anatomic lateral ankle ligament reconstruction with autogenous or allogenic tendons. Several techniques have been described and most require the creation of two transosseous tunnels in the distal fibula, one for the ATFL and one for the CFL.
The popularity of these procedures has been increasing over the last decade with good success reported in terms of high patient satisfaction postoperatively and decreased ankle instability with improved talar tilt and ligamentous laxity.
Tunnel size, placement, and creation in the bone that had previously been weakened by anchors are all possible factors leading to fracture. In addition, sclerotic bone and further trauma worsen the chance of fracture.
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