Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability

Abstract: Ankle sprains are among the most common injuries sustained during sports and physical activity. Around 2 million ankle sprains occur per year with ~85% of them being lateral ankle sprains. Lateral ankle sprains involve damage to the lateral ligamentous complex of the ankle. Patients with a history of lateral ankle sprains are at a 3.5× greater risk of re-injury than those who do not have a history of lateral ankle sprain. Repeated damage to the lateral ligamentous complex can result in the development of chronic lateral ankle instability (CLAI). CLAI can be managed conservatively or surgically. Given the frequency with which sprains occur, and the relative infrequency of symptoms requiring an operation, 80 to 85% of patients can be managed conservatively with good results and minimal disability. However, even with conservative treatment, a 56 to 74% recurrence rate of ankle sprain has been reported. Patients with CLAI who continue to display persistent symptoms after rehabilitation through conservative measures may require surgical intervention. These surgical techniques include direct ligament repair, anatomic reconstruction, and nonanatomic reconstruction. In this chapter we will discuss these procedures, along with their implications and associated risks. We offer different surgical techniques to manage CLAI and available outcome data. Level of Evidence: Diagnostic level 4, case series.