Anatomical Arthroscopic Graft Reconstruction of the Anterior Tibiofibular Ligament for Chronic Disruption of the Distal Syndesmosis Jesús Vilá-Rico,

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Anatomical Arthroscopic Graft Reconstruction of the Anterior Tibiofibular Ligament for Chronic Disruption of the Distal Syndesmosis Jesús Vilá-Rico, M.D., Ph.D., Enrique Sánchez-Morata, M.D., Ph.D., Elena Vacas-Sánchez, M.D., Cristina Ojeda-Thies, M.D., Ph.D. Arthroscopy Techniques Volume 7, Issue 2, Pages e165-e169 (February 2018) DOI: 10.1016/j.eats.2017.08.064 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Identification of fibular and tibial insertions of the anterior-inferior tibiofibular ligament. Arthroscopic view through the anteromedial portal, right ankle. (A) Fibular insertion proximal to anterior talofibular ligament. (1) Fibula. (2) Talus. (B) Drilling of tibial insertion near Tilleaux tubercle using an anterior cruciate ligament guide wire (arrow). (1) Fibula. (2) Talus. (3) Tibia. Note the graft suture in the fibular tunnel in the background (*). Arthroscopy Techniques 2018 7, e165-e169DOI: (10.1016/j.eats.2017.08.064) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Insertion of graft through the anterolateral portal. Arthroscopic view through the anteromedial portal, right ankle. (A) Sutures attached to both ends of the grafts in the fibular (*, blue strands) and tibial tunnels (†, white strands). (1) Fibula. (2) Talus. (3) Tibia. (B) Insertion of tibial end of graft into the bone tunnel. (1) Fibula. (2) Talus. (3) Tibia. (4) Graft. The fibular suture is in the background (*). Arthroscopy Techniques 2018 7, e165-e169DOI: (10.1016/j.eats.2017.08.064) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Final construct of the anterior-inferior tibiofibular ligament graft reconstruction. (A) Arthroscopic view through the anteromedial portal, right ankle. (1) Fibula. (2) Talus. (3) Tibia. (4) Graft. (B) Schematic view. *ACL suture button fixation of tibial end. †Biotenodesis screw for fibular end. Arthroscopy Techniques 2018 7, e165-e169DOI: (10.1016/j.eats.2017.08.064) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions