Ankle instability

Ankle instability

Ankle ligament injuries are one of the most common injuries of all, especially in sports. Almost everyone has fallen and twisted their ankle at some point in their life. The vast majority of these injuries do not require surgery and can be successfully treated using conservative therapy. 

While simple injuries such as strained ligaments often heal well without any specific therapy, higher-grade capsular ligament injuries must be treated with ankle orthotics and targeted physiotherapy to achieve the best possible recovery. 

However, chronic ankle instability does develop in 20–40% of cases despite adequate treatment. After the initial trauma, patients often report repeated twisting, sometimes with brief acute swelling and often accompanied by feeling instable on uneven ground and pain resulting from strain. It is not uncommon for mobility to be restricted, either due to capsular scarring or osteophytes on the anterior tibia or talus. In the case of symptomatic chronic ankle instability with no improvement despite ongoing physiotherapy, surgical ligament reconstruction is indicated. Surgery can be open, arthroscopic, or arthroscopy-assisted. For modified Broström-Gould anatomic reconstruction, the native instable ligamentous structures are first detached, then shortened, and reaffixed with the correct tension using small suture anchors (usually on the anterior outer ankle), thus addressing mild rotational instability. If the residual native structures are insufficient for use, various ligament slings using grafts or plastic bands (ligament bracing) can be implemented both laterally and medially.

In the case of complex injuries involving tibiofibular syndesmosis or multiple ligament ruptures (three-ligament injuries) in physically active patients, immediate surgical therapy via arthroscopy and ligament suturing or ligament reconstruction may also be necessary.