Chronic lateral instability of the ankle in athletes

Acute lateral ligament injuries of the ankle are best treated nonsurgically, with peroneal strengthening and neuromuscular training. At least 80 to 90% of patients will regain satisfactory ankle stability after functional treatment. Chronic ankle instability occurs in approximately 10 to 20% of patients after acute ligament injuries, irrespective of primary treatment. Surgical reconstruction may be necessary, especially in athletes with high demands on ankle joint stability. Numerous different surgical procedures have been described many with some kind of a tenodesis. The classic tenodeses, Evans, Watson-Jones and Chrisman-Snook, have all been used with good short term results. Anatomical ligament reconstruction using the remnants of the ruptured and elongated ligaments, with shortening, reinsertion and duplication, have been shown to be simple, effective and free from complications. As the results of anatomical reconstruction are satisfactory both in the short and the long term, this reconstruction is recommended for correction of lateral ankle instability.