Using double-bundle Achilles tendon-bone allograft for reconstruction of compound loss of lateral malleolus and lateral ankle ligaments: A rare case report.
Hsuan Chiu, Jen Hung Chen
✦ AI-curated · Sources linked
Case in brief
A 26-year-old woman developed progressive right ankle pain, recurrent giving-way, and peroneal tendon subluxation years after a high-energy crush injury requiring flap coverage. Imaging showed an approximately 5 × 3 × 2 cm distal fibular defect with lateral malleolar loss, chronic varus instability, complete ATFL and CFL ruptures, and peroneal tendon dislocation. A single-stage reconstruction used a cryopreserved Achilles tendon-bone allograft to restore the lateral malleolus and reconstruct both ligaments; the peroneal tendons were reduced. At 16 months, she walked pain-free with a stable ankle, graft incorporation, intact ligament grafts, and maintained tendon reduction.
What made this case unusual
The reconstruction addressed a combined defect—lateral malleolar bone loss, ATFL/CFL rupture, and peroneal tendon dislocation—in an ankle previously treated with flap coverage, using one Achilles tendon-bone allograft for bone and ligament reconstruction.
Diagnostic / clinical pearl
When lateral ankle instability coexists with substantial distal fibular bone loss and peroneal tendon dislocation, assess the osseous and ligamentous deficits together; this case illustrates a single-stage allograft reconstruction addressing both.