Achilles Allograft Reconstruction for Ankle Multiligament Injuries in a Patient Presenting With Rotational Ankle Instability: A Surgical Technique

The ankle comprises two main ligamentous complexes: the medial and lateral complex. In cases of chronic ankle instability following a sprain involving both complexes, rotational ankle instability can develop. We introduce a 25‐year‐old male with rotational ankle instability who reported having 20 episodes of “giving away” over the 6 months following an ankle sprain. Due to persistent instability, the patient was deemed a candidate for surgical reconstruction. An Achilles tendon allograft was utilized to reconstruct four ligaments—two from the lateral complex (the anterior talofibular ligament [ATFL] and calcaneofibular ligament [CFL]) and two from the medial complex (the tibiocalcaneal ligament and anterior tibiotalar ligament, components of the deltoid ligament). At the final follow‐up, the patient’s American Orthopedic Foot and Ankle Society (AOFAS) score was 89, the pain level was rated at 2 on the visual analog scale (VAS), and there was no significant restriction in the range of motion. While arthroscopic repair is the preferred option, an open surgical approach was chosen to adequately address all the ligamentous injuries, as the patient had two complete ruptures in addition to two partial tears.