Table 2.
Surgical Procedures, and Pearls and Pitfalls
| Surgical Procedures | Pearls | Pitfalls |
|---|---|---|
| Portals | It is essential to have the portals correctly placed: always use needles. | Portal malposition could lead to poor visualization, difficult maneuverability, and tunnel malposition. |
| Working space creation | Limited dissection to form a working space is recommended. | If the working space is too small, visualization and instrumentation could be very difficult. If the working space is too large, tissue damage will be increased and incision dehiscence would be resulted. |
| Tunnel creation | Preoperative computed tomography examination and measurement will be helpful for tunnel creation. The diameter and depth of the tunnels should be tailored by computed tomography calculation. | Wrong-sized or malpositioned tunnel could result in talar neck or fibular bone fracture. |
| Graft fixation | The graft thickness should be at least 3 mm in diameter and have good quality. | Poor quality of the graft could lead to graft breakage by the interference screw. |
| The diameter of the interference screw at the talar side is 1 mm less than that of the bone tunnel if hard bone is encountered. | Graft breakage would be resulted by the interference screw that has the same diameter as the hard bone tunnel. | |
| The diameter of the interference screw at the calcaneal side should be equal to or 1 mm thicker than that of the bone tunnel if soft bone is encountered. | Graft fixation failure at the calcaneal side in the osteoporotic patients could lead to ankle instability recurrence. | |
| If the graft is more than 3 mm thick, the folded part of the graft, which is intended to be inserted into the 6-mm fibular tunnel, can be trimmed a little smaller to facilitate insertion. | The graft can be damaged or the fibular tunnel could be broken if the graft loop is larger than the fibular tunnel. | |
| Incision healing | Postoperative drainage is helpful. Sustained compression around the ankle is required until the incision is healed. |
Incision dehiscence will be resulted due to the hematoma formation in the working space. |