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

Introduction and importance: 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.Case presentation: 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.Clinical discussion: 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.Conclusion: 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.