Morphix® Suture Anchor System – Surgical Technique Guide Morphix® Suture Anchor System – Surgical Technique | Page 2

Lateral Ankle Ligament Repair
!
Lateral Ankle Ligament Tears
1
Ankle sprains are the most common injuries sustained during sporting activities. Although approximately 80% of ankle
sprains make a full recovery, the remaining 20% develop mechanical or functional instability leading to chronic ankle
2
instability. Chronic ankle instability results in continued pain, diminished recreational activities, and potentially early
degenerative changes in the ankle. The majority of ankle injuries involve the lateral ankle ligament complex, which is
comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular
ligament (PTFL). The mechanism of lateral ligament injury is most often forced plantar flexion and inversion of the ankle
1
as the body’s center of gravity rolls over the ankle. The ATFL is the weakest of the lateral ankle ligaments; therefore, it
is the most frequently torn. In fact, of the 105 sprained ankles surgically explored by Brostrom, two-thirds were found to
3
have ATFL tears and one-quarter involved combined ATFL and CFL tears.
Indications for Lateral Ankle Ligament Repair
Indications for lateral ankle ligament repair include at least six months of persistant symptomatic instability despite
failed conservative treatment of functional rehabilitation.
Anatomic Lateral Ankle Ligament Repair
A myriad of surgical procedures have been described to treat lateral ankle ligament instability. These procedures can
be classified as anatomic repairs, anatomic reconstructions, or non-anatomic reconstructions. Herein, we describe a
4
technique for anatomic repair. Brostrom first described midsubtance repair of the ATFL and CFL in 1966. Gould further
5
modified this technique by incorporating repair of the inferior extensor retinaculum. Karlsson et al. reported an
6
additional modification to ligament repair, wherein the lateral ligaments are reattached to the fibula through drill holes.
Today, the latter technique is typically performed utilizing suture anchors in the fibula to imbricate the ATFL and
possibly the CFL with additional repair of the inferior extensor retinaculum and fibular periosteum.
1
2
Chan, K.W., B.C. Ding, and K.J. Mroczek, Acute and chronic lateral ankle instability in the athlete. Bull NYU Hosp Jt Dis, 2011. 69(1): p. 17-26. Baravarian, B., et al.,
3
Treatment of chronic lateral ankle instability and associated pathology. Foot Ankle Spec, 2008. 1(6): p. 359-62. Brostrom, L., Sprained ankles. 3. Clinical observations in
4
recent ligament ruptures. Acta Chir Scand, 1965. 130(6): p. 560-9. Brostrom, L., Sprained ankles. VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand,
5
6
1966. 132(5): p. 551-65. Gould, N., D. Seligson, and J. Gassman, Early and late repair of lateral ligament of the ankle. Foot Ankle, 1980. 1(2): p. 84-9. Karlsson, J., et al.,
Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am, 1988. 70(4): p. 581-8.a
Morphix ® Design Highlights
PRE-COMPRESSED LOW PROFILE
GEOMETRY FOR EASY INSERTION
Suture Eyelet
Compressed Wings
Suture Channel
INSERTER HANDLE FOR SIMPLIFIED
DEPLOYMENT BY TAP-IN TECHNIQUE
DEPLOYMENT WINGS EXPAND 200% FOR
HIGH BEARING AREA AND SECURE FIXATION
Eyelet Lock prevents
eyelet migration after
deployment
Deployment Wings
expand 200%
Suture Cleats
Cannula
Profile of Inserter Handle Wings shows
direction of wing expansion during deployment
Inserter Knob
Page 1