Introduction We report a modified technique using peroneus brevis for reconstruction of the anterior talofibular and calcaneo-fibular ligaments in the ankle for chronic instability.

Method The surgery was carried out using a double drill-hole in the distal fibula with either a complete or partial tendon graft. An examination under anaesthetic with ankle arthroscopy has been utilised to confirm the clinical diagnosis and assess the articular surfaces. In appropriate cases a translational os calcis osteotomy is added to correct varus hindfoot deformity.

Forty-five procedures were carried out over a 10-year period. The patients were retrospectively assessed with a case note review, and an updated clinical evaluation. The assessment focussed on pain, stability and impact on daily living.

Results Our results compare favourably with existing techniques for lateral ligament reconstruction, with most patients being satisfied with the improvement in pain relief and stability. These will be discussed in detail. Complications included superficial wound infections and sensory neurological symptoms. There were two failures following surgery both of which were associated with a high body mass index and joint laxity.

Conclusion This procedure provides anatomical reconstruction, is technically undemanding and gives adequate pain relief, stability and return to sporting activity. With careful patient selection, including treatment of intra-articular pathology and hindfoot deformity, it is a useful alternative to the methods currently available.