Ankle instability is a common sequelae of a lateral ankle sprain. Surgery for this condition must address any intra-articular pathology as well as repairing the ligaments. The former is generally done arthroscopically and the advantages of this approach are well documented. However, once this is competed the second stage of ligament repair is traditionally done in an open manner. There is increasing interest in the role of arthroscopic ligament repair though to date most techniques have repaired only the anterior talofibular ligament and then performed a percutaneous retinacular advancement. The only technique that addresses the calcaneofibular ligament (CFL) does so from an accessory portal just anterior to the tip of the fibula though in practice it can be difficult to see the CFL from this portal. We have developed the technique of lateral ankle endoscopy, performed through the bed of the peroneus brevis tendon. This technique gives direct and clear visualization of the CFL, anterior talofibular ligament, and also the extensor retinaculum, which then allows direct, anatomic tightening. The stabilization is performed with bone anchors onto the fibula. We present the results in 15 consecutive cases performed with this entirely arthroscopic technique. We believe that this technique gives better visualization of the structures than an open technique and that as a result a more anatomic reconstruction can be performed.
Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.