Fig 3.

Creation of the talar tunnel (left ankle). (A) The anteromedial synovium and ATTL remnant around the ATTL talar footprint are dissected using a shaver and a radiofrequency probe. A microfracture awl is used to mark the ATTL talar footprint, which is immediately inferior to the articular cartilage of the trochlea,²¹ and a 2.4-mm guidewire is inserted through the AAM portal to drill the talus from the ATTL footprint toward the lateral side of the talar neck. (B) The insertion point should be posteroinferior to the anteromedial corner of the trochlea of the talus.²¹ Intraoperative fluoroscopy is used to confirm guidewire insertion position²² by touching with a drill tip. (C) The guidewire is then overdrilled using a drill with the same or a 0.5-mm larger diameter than the graft end to create a 20-mm-deep talar tunnel. (Patient 1 is shown in all panels.) (AAM, accessory anteromedial; ATTL, anterior tibiotalar ligament; MM, medial malleolus.)