Surgical versus nonoperative treatment for severe acute lateral ankle ligament injuries: A long-term follow-up study

This study evaluates outcomes and long-term reinjury rates in patients with severe lateral ankle ligament injuries treated surgically versus nonoperatively. A combined surgical and arthroscopic approach was used for such cases. From 2004 to 2013, 103 patients with acute lateral ankle ligament injuries and a talar tilt angle (TTA) of ≥ 15° underwent surgical treatment. At 3 months postoperatively, TTA reassessment in 85 feet (82.5 %) showed a mean improvement from 23.9° to 5.8°. The mean AOFAS score reached 97.1 points at 3 months, reflecting excellent patient outcomes. In contrast, 132 patients received nonoperative treatment. Although TTA improved from 19.3° to 8.5° with nonoperative treatment, the follow-up rate was lower (28.2 %) than among those undergoing surgery. Sixty patients returned to the clinic until 2024 for follow-up due to re-sprains. Among the 103 patients in the surgical treatment group, 18 experienced re-sprains. Although no additional surgery was required, 4 patients developed chronic lateral ankle ligament instability. Of the 132 patients in the nonoperative treatment group, 42 experienced re-sprains; 6 patients progressed to chronic instability. Despite the high success rate of nonoperative treatment for lateral ankle ligament injuries, surgery is recommended for patients with a TTA of ≥ 15°. Approximately 90 % of patients may achieve favorable outcomes with conservative management, while a subset may progress to chronic ankle instability. Although surgery involves potential drawbacks, the benefits often outweigh the risks, particularly in patients with severe ligament damage.