Multiligament ankle instability: Case report and therapeutic perspectives

Severe ankle sprains involving complex ligament injuries represent a significant challenge in sports traumatology. These injuries often include damage to the syndesmosis, lateral and medial ligaments, and associated intra-articular structures. Early diagnosis and appropriate surgical management are crucial to prevent chronic instability and long-term functional impairment.

We report the case of a 19-year-old male football player who sustained a severe ankle injury during a match. The mechanism of injury involved forced external rotation with weight-bearing. Initial examination revealed significant swelling, extensive bruising, and tenderness around the ankle. Imaging studies confirmed syndesmotic injury with external rotation of the fibula, anterior widening of the syndesmotic gap, and osteochondral fragments in the ankle joint. Surgical management included dynamic fixation of the syndesmosis with four suture buttons, anatomical ligament repair using anchors, and removal of osteochondral fragments. Postoperative rehabilitation involved immobilization followed by progressive mobilization and proprioceptive strengthening. At twelve months, the patient had regained full, pain-free ankle stability and returned to sports activities.

The management of complex ankle injuries requires a multidisciplinary approach integrating advanced surgical techniques such as dynamic syndesmotic fixation and ligament reinsertion. Compared to rigid screws, suture buttons offer enhanced physiological micromotion and eliminate the need for implant removal. Intra-articular pathologies, frequently associated with such injuries, further complicate treatment and may benefit from arthroscopic techniques. Rehabilitation protocols focusing on early mobilization and proprioceptive training are essential for optimal recovery.

This case highlights the importance of comprehensive surgical and rehabilitative management in treating severe combined ankle injuries. Advances in dynamic fixation and arthroscopic repairs hold promise for improving functional outcomes and minimizing long-term complications.