Fig 4.

Suture anchor placement and anterior talofibular ligament (ATFL) remnant repair (right ankle). (A) The surgeon penetrates from the fibular tunnel bottom to the opposite cortex with a 2.9-mm drill wire through the subtalar portal. A 2.9-mm JuggerKnot Soft Anchor, which has 2 sets of threads, is placed at the fibular cortex behind the fibular tunnel. The first set of suture anchor threads is used to grab the ATFL remnant via a lasso-loop technique. An 18-gauge hollow needle with No. 2-0 nylon thread penetrates the ATFL remnant through the accessory anterolateral or subtalar portal depending on the accessibility of the remnant. The nylon loop is retrieved through the same portal using a grasping instrument, and the needle is withdrawn. One end of the first thread set is then passed through the nylon loop, which is used to pull just the mid portion of the suture anchor through the ATFL remnant such that a suture loop is created in the ATFL remnant. (B) The free end of the first set of suture anchor threads is passed through the loop and pulled tight, creating a self-cinching lasso loop. (C) The other end of the first thread set is used to draw the lasso loop, tightening the ATFL remnant. (Figs 4A and 4C are from patient 2 whereas Fig 4B is from patient 1 because of image quality.)