Fig 2.

Illustrations and arthroscopic views of arthroscopic anterior talofibular ligament (ATFL) repair. (A) Footprint of the torn ATFL is debrided. (B) Suture passer is passed through the accessory anterolateral (acAL) portal and used to penetrate the ATFL from inferolateral to superomedial. (C to E) Nitinol loop wire is passed through the suture passer and pulled out through the acAL using a retriever. (F) Drill guide is placed through the acAL portal in the ATFL insertion site. (G) Hole is drilled from the distal to proximal and anterior to posterior direction, and the knotless anchor is inserted through the drill guide. (H and I) Repair suture is loaded through the Nitinol wire loop which is then pulled back. (J) End of the repair suture is run from the acAL portal through the ligament and back to the acAL portal. (K) Repair suture is loaded through the loop of the shuttling suture. (L) Free end of the shuttling suture is pulled to shuttle the repair suture back into the anchor, and shuttle suture is advanced with repeated light tugs until the suture is passed through the suture splice locking mechanism and back out the acAL portal. (M and N) Free end of the repair suture is pulled until desired tension is achieved. A, remnant of the anterior talofibular ligament; F, fibula; V, medial midline portal; P, accessory anterolateral portal; T, tibia or talus; Y, remnant of anterior talofibular ligament attached to the fibula; ￥, repaired anterior talofibular ligament.