Fig 6.

Tendon graft fixation (left ankle). (A) The ATTL graft is tensed by pulling of the suture anchor thread at the tibial tunnel and the strands are tied. (B) Subsequently, the graft is fixed with an appropriate diameter 15-mm-long bioabsorbable interference screw in the talar tunnel with the ankle in the 45 to 60° plantar flexion position to avoid restricted postoperative plantar flexion for most patients. (C) Viewed from the AM portal, the ATTL graft is tensed by plantar flexion or external rotation stress. (Patient 1 is shown in all panels.) (AM, anteromedial; ATTL, anterior tibiotalar ligament; MM, medial malleolus.)