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Rationale: With the development of ankle arthroscope techniques and procedures, the number of arthroscopic modified Broström procedures (MBPs) is increasing. All-inside arthroscopic MBP was developed recently, with good to excellent results. However, several complications have been reported in patients after arthroscopic MBP. This case report describes a rare complication of arthroscopic MBP., Patient Concerns: A 34-year-old woman presented with severe pain in her right ankle and underwent arthroscopic MBP for lateral ankle instability. About 6 months postoperatively, she presented with severe pain on the lateral aspect of the right ankle, especially while walking., Diagnosis: In physical examinations, there was marked swelling around the ankle and focal tenderness in the posterolateral malleolar area. Ankle ultrasonography showed a diffuse low-echoic mass-like lesion at the distal fibula between the fibular tip and peroneus tendon. T1-weighted sagittal magnetic resonance imaging images showed an irregularly shaped mass-like lesion with a heterogeneous signal near the distal fibula posteriorly where the anchor protruded., Interventions: The suture anchor in the posterior distal fibula area, which had irritated the peroneus tendon, was removed with debridement of the granulomatous lesion., Outcomes: At the 3-month follow-up, the patient was almost asymptomatic and had a nearly full range of motion. No complications or recurrent symptoms were noted at the 1-year follow-up., Lessons: Three-dimensional computed tomography studies of the appropriate fibular depth and position of suture anchors are needed to standardize the procedure and reduce complications.

Rationale: Stress fractures are most commonly sustained in the lower extremities owing to the repetitive weight-bearing forces. They are overuse injuries that are seen often in athletes, but rare in the general population, so early diagnosis and proper treatment are important to enable athletes to return to activity. This is a rare example of successful treatment of a medial malleolar stress fracture with lateral ankle instability., Patient Concerns: A 16-year-old athlete presented with acute-onset left ankle pain. He was a baseball pitcher who had previously sprained left ankle while training. Subsequently, the ankle pain worsened, and he had tenderness on the medial aspect of his left ankle. The symptoms were mild at rest, but increased upon walking and training. Three years previously, he had sprained his ankle several times during baseball training., Diagnosis: Plain standing radiographs of the left ankle showed a vertical fracture line in the medial malleolus. Computed tomography also showed the vertical fracture in the medial malleolus. Magnetic resonance imaging revealed mild bone marrow edema in the medial malleolar area and total rupture of the anterior talofibular ligament., Interventions: Surgery was performed under general anesthesia, and we checked the instability of his ankle using a C-arm image intensifier, and the varus talar tilt angle was increased (10.3°). The medial malleolus stress fracture was fixed using tension bend wiring, and an arthroscopic modified Broström procedure was done., Outcomes: Two months postoperatively, the patient started walking, and raised-heel squatting. The medial malleolar fracture was completely united at the 3 months postoperatively on plain radiography, and return to full activity was achieved by 3 months postoperatively. Then the hardware was removed 1-year after operation and both the anterior drawer and external rotation stress tests were negative., Lessons: Medial malleolar stress fractures are rare, so they can be overlooked. With these fractures, plain radiographs are frequently normal initially because the medial malleolus consists mainly of cancellous bone. Physicians require a high level of suspicion when taking the patient's history and doing the physical examination. Because most occur in athletes, early diagnosis and proper treatment are important for patients' subsequent athletic performance.

Rationale: Suture anchors are increasingly used to fix soft tissue to bone. Favorable outcomes of the modified Brostrom operation (MBO) using suture anchors have been reported. However, to the best of our knowledge, few complications of suture anchors used in ankle surgery have been described. Here, we present a rare case of successful treatment of a chronic sinus tract infection developing after the MBO using a suture anchor., Patient Concerns: A healthy 18-year-old high school student presented with a chronic ulcerative wound in his right ankle 1 year after anterior talofibular and calcaneofibular ligament repair using a suture anchor at a local clinic. Clinical examination revealed a 1.5 × 2-cm-sized ulcerative wound, accompanied by a red-black discharge, on the anterior border of the right lateral malleolus. The wound could be approximated to the joint capsule level using a forceps., Diagnosis: A simple standing anteroposterior radiograph of the right ankle revealed mild, lateral soft-tissue swelling. Magnetic resonance imaging showed that a sinus tract running from the wound to the talar body crossed the anterior joint capsule, and bone marrow edema surrounding the talus., Interventions: We removed the sinus tract and the infected suture anchor. We rendered the wound zigzag-shaped and then performed simple suturing and applied a short leg cast., Outcomes: The wound healed completely by 4 weeks after surgery. The patient reported no complication or recurrence of infection at the 1-year follow-up., Lessons: To obtain wound healing, the chronic sinus tract must be removed. If the suture anchor is the cause of infection, it should be removed.