Fig. 4

Surgical procedure. a Tibiofibular appearance as assessed with axial computed tomography. b First canal (3.5 mm in diameter) drilled into the distal fibula in posteromedial direction and 1.5 cm above the tibial plafond. c Second canal (3.5 mm in diameter) drilled through the tibia at the level adjacent to the fibular canal and directed anteriorly toward the anterior tibial cortex 1.5 cm above the syndesmosis. d Third canal (3.5 mm in diameter) drilled slightly cranially to the aforementioned fibular canal, and directed posterolaterally from the medial aspect of the fibula. e Surgical procedure illustrating the direction of the split peroneus longus tendon graft and numbered (1-4) according to the steps of its trajectory (4). Norkus and Floyd illustrates tendon free end anchored with a vicril suture