• Ankle sprains are common injuries in both athletes and the general population.¹,²,³,⁴

• Most ankle sprains occur in sports, with a considerable economic and social impact.¹,⁴

• The most common mechanism of injury is an inversion twist of the ankle, which injures the lateral ligament complex.²,³,⁴

• The surgical options include anatomic repair (Broström technique and modifications), anatomic reconstruction with autograft or allograft, and nonanatomic reconstructions (also known as checkrein procedures) such as the Watson-Jones, Evans, and Chrisman-Snook procedures.⁵,⁶,⁷,⁸,⁹,¹⁰,¹¹,¹²

• Anatomic repairs have the advantage of restoring the anatomy and kinematics of the ankle while preserving subtalar joint motion.¹³,¹⁴,¹⁵

• The patient is positioned supine on the operating table, and intravenous antibiotics are administered.

• A bump is placed under the ipsilateral hip.

• A proximal thigh tourniquet is preferred.

• The lower leg is prepared and draped in a standard fashion.

• We usually perform a diagnostic ankle arthroscopic examination (21-point as described by Ferkel)16 before the ligament repair to ensure a thorough evaluation of the ankle and appropriate treatment of incidental lesions. These may include chondral injury and tibiotalar impingement, which may cause pain after returning to sport, if not treated. All pertinent landmarks are drawn out before the start of the procedure: medial and lateral malleoli, anterior tibial tendon, intermediate dorsal cutaneous branch of the superficial peroneal nerve, and standard arthroscopic portals.

• An Esmarch bandage can be used to exsanguinate the limb, and the tourniquet is inflated.

• For the skin incision, we prefer a standard curved incision just anterior to the lateral malleolus, extending from the ankle joint to the peroneal tendon sheath.