Ultrafast Return to Sport in International Feminine Football Following Arthroscopic Anatomic Lateral Ankle Ligament Reconstruction Using Gracilis Autograft: A Case Report.

Abstract

Lateral ankle instability is a common condition in elite football, but returning to play following arthroscopic anatomic ligament reconstruction (AALR) typically requires 4-6 months. We report the case of a 24-year-old professional female football player who achieved a full return to elite competition and national team duties within 12 weeks following arthroscopic ALR of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments using an autologous gracilis graft. Preoperative instability followed recurrent sprains incurred during the World Cup, with examination and imaging demonstrating complete lateral ligament complex insufficiency. Arthroscopic exploration identified a complete ATFL/CFL rupture, anterolateral impingement, and a lateral talar chondral rail lesion, which were treated by synovectomy, debridement, and AALR. Rehabilitation followed an intensive, criterion-based protocol integrating immediate full weight-bearing, progressive range of motion, neuromuscular training, strength symmetry targets, and field-based functional testing. At 12 weeks, the athlete achieved full functional symmetry: AnkleGO score 25/25, FAAM-ADL and FAAM-Sport 100%, ALR-RSI 100%, symmetric hop performance, and unrestricted football-specific metrics. She returned to international duty without restrictions and completed full match participation. This case illustrates that arthroscopic anatomic reconstruction combined with structured high-performance rehabilitation can enable ultrafast return to elite football, challenging conventional timelines while illustrating an accelerated, criterion-based return in a single elite athlete rather than a generalizable target.