Fig 4.
Creation of the tibial tunnel (left ankle). (A) The ATTL remnant is dissected at the tibial footprint. A guidewire is inserted through the AAM portal. Intraoperative fluoroscopy is used to confirm the guidewire position. The insertion point should be on the anterior colliculus of the MM.23 The angle between the guidewire direction and the long axis of the tibia on the lateral view is 20 to 40°. (B) The guidewire direction is almost on the middle line of the MM in the anteroposterior view. (C1) Viewed from the AM portal, the guidewire is then overdrilled to create a 30-mm-deep tibial tunnel. (Patient 1 is shown in all panels.) (AAM, accessory anteromedial; AM, anteromedial; ATTL, anterior tibiotalar ligament; MM, medial malleolus.)