Minimally invasive ALL technique using the gracilis in the treatment of chronic ankle instabilities in athletes

Introduction and importance: Chronic ankle instability is a common issue in high-level athletes, affecting up to 48 % of lateral sprains. Rehabilitation strategies, including muscle strengthening, proprioceptive training, and range of motion exercises, often help but may not suffice, especially in sports that stress the ankle in a varus position. In such cases, surgery is required. Non-anatomic techniques have shown long-term ineffectiveness, while anatomical reconstructions with tissue augmentation are gaining favor. Case and technique presentation: This study introduces the underreported ALL (Ankle Lateral Ligamentoplasty) technique, using gracilis tendon transfer for chronic ankle instability. This minimally invasive method restores the ruptured lateral collateral ligaments and preserves proprioceptive and anatomical stability, with the added benefit of sparing the semitendinosus tendon for potential knee surgery. Discussion: The surgical procedure allows immediate walking post-op with progressive recovery, including early mobilization, brace use by the fourth week, and return to pivot sports by the third month. Compared to tenodesis procedures, anatomical reconstruction offers superior stability and mobility, faster recovery, and less risk of degenerative arthritis. Conclusion: The ALL technique shows promise in treating chronic ankle instability in athletes, providing effective stabilization while preserving ankle function. However, further studies are needed to validate its widespread clinical use.