Table 1 The specific surgical procedure

LARS

LARS surgery uses a single incision and approach similar to MBG, adding two 1 cm incisions. Use the most distal incision to fix the CFL limb of the LARS to the natural attachment point on the calcaneus, use the proximal incision to pull the LARS ring over the fibular tunnel, and drill a strip through the fibula where the ATFL and CFL attachments overlap. 5 mm tunnel, targeting the proximal and posterior sides of the center of the fibula. At the end of the ATFL, make a 1 cm incision. Drill a tunnel. Then, it is advanced into the fibular tunnel. At the midpoint between the tip of the lateral malleolus and the sole, a 1 cm horizontal incision is made parallel to the posterior surface of the fibula. The surgeon drilled another tunnel, and the two limbs of the LARS were anchored to their respective distal attachment points with anchors. The proximal end of the anchor is passed along the fibular tunnel, tension is applied to the two limbs separately to form a stable ankle joint, and a third anchor is used for final fixation. Finally, close the wound

1. It is beneficial to the healing of the lateral collateral ligament of the ankle joint

2. It provides higher fixation strength than MBG surgery

1. Higher incidence of foreign body is and osteoarthropathy

The surgical procedure described by Karlsson et al

The ligaments and joint capsule are separated approximately 1–2 mm from the anterior and inferior borders of the fibula. After the surgeon lifted the periosteal flap of the fibula, a small bone fragment was chiseled about 4 × 4 mm from the anterior and lateral sides of the fibula—drill holes in the fibula with a 2.0 mm drill. The ligaments and joint capsule are shortened to an appropriate length and sutured to the bone. Tighten the stitches, so the foot is in a neutral position. Finally, the surgeon performed duplication with a periosteal flap and the proximal end of the ligament to strengthen the reconstruction

1. Simple operation

2. Simple technique

3. Small economic cost

4. Fewer complications

1. High requirements for local residual ligaments

The Chrisman-Snook procedure

A posterior curved incision is made from 4 to 5 cm proximal to the top of the fibula to 2 cm proximal to the top of the fifth metatarsal. A flap is formed. The medial half of the peroneus brevis tendon was taken as a graft, retaining its ligamentous attachment to the fifth metatarsal. Use a drill to drill a bone tunnel through the fibula. The separated tendon is passed through the bone tunnel and attached to the junction of the calcaneus with the calcaneofibular ligament. With the ankle dorsiflexed 10°, the graft is tensioned and secured to the calcaneus, and the end of the graft is sutured to the anterior portion of the anterior talofibular ligament

1. Effectively limit the inclination of the talus, which is a good simulation of ankle motion similar to the intact ligament

1. Inability to fully restore the role of the pre-injured ligaments

MBG + ST

An oblique longitudinal incision was made from the posterior end of the fibula in the direction of the fourth metatarsal. The surgeon lifted the 1 cm periosteum from the distal end of the fibula to the proximal end, and the residual ATFL and CFL were cut off. Insert an anchor along the insertion point on the lateral wall of the ATFL talus and the corresponding location on the fibula. The surgeon inserted two more suture anchors, one at 5 mm proximal to the CFL and the other at 18 mm. The periosteal flap combines the inferior extensor retinaculum with absorbable sutures, and the skin is sutured

1. Provides higher fixation strength than MBG surgery, and can reach pre-injury movement levels faster

2. Low risk of complications

1. Higher cost of surgery

MBG

A curved incision was made behind the fibula to repair the damaged ligament directly, and the unique bundle of the IER was sutured to the lower segment of the fibula

1. The technology is mature and more people accept it

1. Extensive exposure, easy to damage nerves

2. It is not effective for patients with high BMI and extensive ligament laxity