Fig 3.

Creation of the ST portal and the fibular tunnel (the left ankle). (A) The ST portal is created just below the FOT¹⁷ after confirming accessibility to the fibular footprint by a needle. (B) A guidewire is inserted through the ST portal. Intraoperative fluoroscopy is used to confirm the guidewire position. The insertion point should be proximal to both the articular tip and the FOT.¹⁸ The angle between guidewire direction and the long axis of the fibula on the lateral view is 10° to 30°. The guidewire direction is almost on the angle bisector of the fibular end on the anteroposterior view. (C) Viewed from the AAL portal, the guidewire is overdrilled to create a 20 mm-deep fibular tunnel. All panels are from patient 1. (AAL, accessory anterolateral; AM, anteromedial; FOT, fibular obscure tubercle; ST, subtalar.)