A 29-year-old male soldier presented to the orthopedic clinic complaining of left ankle pain that started one year prior while he was playing football. He had a height of 158 cm and a BMI of 33.3. He is a current smoker and had a medical history of hypertension and pericarditis. On clinical assessment, he was found to have moderate ankle pain and ankle joint locking and giving way. He was started on a trial of conservative treatment, which consisted of serial casting for six weeks, NSAIDs for analgesia, and physiotherapy for exercises to strengthen and stretch the injured ankle for six months, but his symptoms showed no improvement. Consequently, an MRI was ordered, which showed no ligament or tendon injuries. However, degenerative subchondral cystic changes were found in the distal tibia and talar dome. As his pain and instability symptoms persisted, surgery was booked for left lateral ankle ligament repair. Intraoperatively, there was evidence of laxity in both the ATFL and CFL, so the reconstruction of the CFL and ATFL was performed by the modified Brostrom technique. After the surgery, a cast was applied below the knee for the left lower limb, and the patient was referred for physiotherapy. Postoperative assessment in the next one year showed that the patient's ankle pain and instability had resolved (Figures 1A, 1B).
Case 6