Fig 1.

Patient position and graft preparation. (A) The right ankle is the operative side. Surgery is performed under general anesthesia with the patient in the supine position. A tourniquet is placed on the proximal thigh and the foot is suspended from the distal edge of the bed. The contralateral leg (left) is slightly lowered to provide a wide working space. (B, C) A gracilis tendon graft is harvested and a reversed Y-shaped graft is prepared. The semitendinosus tendon is used if the gracilis is too thin or too short. It contains 2 strands of an approximately 20-mm-long bundle for the ATFL and 1 strand of 25- to 30-mm-long bundle for the CFL. The length is determined by preoperative magnetic resonance imaging. The 3 ends form a 15-mm-long loop to facilitate attachment of a thread for graft delivery. Parts (A) and (B) are from patients different from the patient in the video case because of photo quality. (ATFL, anterior talofibular ligament; CFL, calcaneofibular ligament.)