Re-injury after arthroscopic anatomical reconstruction of the lateral ankle ligaments treated by a new arthroscopic anatomical reconstruction: A case report

• Published in: International journal of surgery case reports Vol. 105; p. 107994
• Main Authors: Guyonnet, Clément, Lopes, Ronny
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2023; Elsevier
• Subjects: Anatomic lateral reconstruction; Arthroscopy; Case Report; Lateral ankle instability; Lateral ankle instability; CFL; Arthroscopy; ATFL; Anatomic lateral reconstruction
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.107994

Lateral ankle ligament reconstruction failures are increasingly frequent. To our knowledge no reports of using a new arthroscopic anatomical reconstruction with a gracilis autograft to treat an ankle re-injury have been described. A 19-year-old man presented with a right ankle injury resulting in isolated lateral ankle instability. The clinical examination showed significant laxity. The MRI confirmed a grade 3 tear of the lateral ligament complex. Arthroscopic anatomical reconstruction with a gracilis autograft was performed and the patient was able to return to all of his activities. Eighteen months after the primary reconstruction, he had another high-energy injury. Despite rehabilitation, he experienced isolated lateral instability. Arthrography confirmed graft failure. The patient underwent a new anatomical reconstruction with the controlateral gracilis autograft, with no difficulties. At 6 months, he had returned to all of his activities, with no limitations or discomfort. Articular hypermobility, hindfoot varus and/or excess weight should be looked for or treated to explain the graft failure. Other therapeutic options are possible for revision surgery such as non-anatomical tenodesis, allografts or artificial ligaments. Arthroscopic anatomical reconstruction of the lateral ligaments of the ankle with a new arthroscopic anatomical reconstruction procedure seems to be feasible. Other studies are needed to define the therapeutic strategy for ligament reconstruction graft failures. •Ankle sprains are one of the most common injuries.•Lateral ankle ligament reconstruction re-injuries or failures are increasingly frequent.•There is no consensus on the management of reconstruction after ankle re-injury or graft failure.•New arthroscopic reconstruction with the contralateral gracilis autograft is a feasible option.