Table 3.

Step-by-Step Guide to Performing In-Office ATFL Repair With Suture Tape Augmentation

Step 1: Position the patient supine on an examination table to make the operative ankle easily accessible.

Step 2: Use a chlorhexidine gluconate/isopropyl alcohol sponge-stick to sterilely prepare the ankle and drape the ankle to create a sterile field along the distal half of the examination table.

Step 3: Inject local anesthesia superficially into the anticipated portals.

Step 4: Establish portals with a superficial stab incision followed by blunt dissection Insert the scope into the anteromedial portal initially. Insert shaver into anterolateral portal.

Step 5: Resect part of the AITFL to identify the anatomic foot print of the ATFL on the fibula.

Step 6: Elevate the attachment of the ATFL ligament off of the distal fibula and shave down to bone.

Step 7: Make third portal 1 cm anterior to the tip of the fibula.

Step 8: Insert wire into the fibula and laser line into talus. Introduce FiberTape suture and overdrill with cannulated 3.5 drill to secure into talus.

Step 9: Overdrill fibula with 3.5 drill through anterolateral portal.

Step 10: Pass suture from third portal to the anterolateral portal.

Step 11: Advance swivel lock anchor while maintaining tensions in suture.

Step 12: Check suture tension using a probe before final seating.

Step 13: Ask the patient to actively range their ankle to assess ligament tension.

Step 14: Perform wound closure with Steri-Strips and apply soft dressing or splint as indicated.

ATFL, anterior talofibular ligament.