Arthroscopic Technique for Anterior Calcaneal Process Avulsion Fractures and Bifurcate Ligament Injuries Using Suture Tape Augmentation

Avulsion fractures of the anterior process of the calcaneus are frequently associated with injury to the bifurcate ligament and may result in persistent lateral midfoot pain and instability. Although open fixation or fragment excision has traditionally been used, these approaches may fail to restore ligamentous function and joint stability. Arthroscopic techniques for combined management of bony and ligamentous pathology at the calcaneocuboid joint remain poorly described. We describe an arthroscopic technique for the management of anterior calcaneal process avulsion fractures associated with bifurcate ligament injury. The procedure combines endoscopic excision of symptomatic intra-articular fragments with internal brace augmentation of both limbs of the bifurcate ligament using suture tape fixation, preserving residual native fibers and restoring ligamentous stability. This arthroscopic technique allows minimally invasive management of combined osseous and ligamentous pathology of the calcaneocuboid joint, providing stable ligament augmentation while avoiding the morbidity of open surgery and rigid across-joint fixation. Arthroscopic bifurcate ligament internal brace augmentation may represent a valuable option for selected patients with symptomatic anterior calcaneal process avulsion fractures and associated midfoot instability.