The etiology and repair of rotary ankle instability

The ankle and subtalar joints form a coupling which acts like a universal joint. When the anterior talofibular ligament is disrupted, rotation of the talus about the long axis of the leg is permitted. This abnormal rotation in the transverse plane is the distinguishing feature of rotary ankle instability. The pathomechanics of rotary ankle instability are described. A simple and direct approach to repairing and reinforcing the anterior talofibular ligament and the results of 37 consecutive delayed reconstructions by this method are reported. Advantages of this procedure are felt to be a restoration of the original anatomy, preservation of the peroneal tendons, maintenance of the integrity of the subtalar joint and excellent postoperative results. Disadvantages include a lack of objective diagnostic criteria.