Review Question - QID 218703

A 17-year-old male presents with a history of recurrent lateral ankle sprains while playing on his high school football team. He has become frustrated with the laxity and pain he has on the lateral aspect of his ankle. On exam, he has a grossly positive anterior draw and nearly 20 degrees of ankle inversion on talar tilt testing. In terms of gross alignment, he exhibits an elevated longitudinal arch and hindfoot varus with a prominent callus along the lateral forefoot and weak peroneus longus and posterior tibialis musculature on strength testing when compared to the contralateral side. If he decides to undergo isolated surgical reconstruction of his torn lateral ligamentous complex, which of the following represents the most likely cause of surgical failure and recurrent ankle instability in this patient?