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Chronic ankle instability

97 citationsUpdated Sep 2026

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Overview

Chronic ankle instability is a condition where persistent ligamentous laxity leads to reduced self-reported function compared to healthy individuals or those who have recovered from acute sprains [4]. Accurate diagnosis is critical, as chronic syndesmotic and medial ankle instability are significantly associated with unsatisfactory outcomes [1]. While current imaging studies provide baseline data, arthroscopy offers more accurate information for the definitive assessment of ligament lesions [20]. Clinicians must define all deficiencies before intervention, as operative procedures focusing only on part of the pathology should be approached with caution [43]. The Foot and Ankle Ability Measure (FAAM) is a common assessment tool, though its clinimetric qualities in this specific population require further demonstration [30].

Initial management of chronic lateral ankle instability, particularly in military service members, involves appropriate nonoperative treatment [3]. Surgical management is warranted when nonoperative measures fail to prevent long-term sequelae [3]. Research continues to evaluate non-surgical adjuncts, such as mobilisation with movement (MWM), to determine their effects on anatomical and clinical characteristics at 12 months [5]. A consensus exists on identifying patients requiring surgery and the role of arthroscopic treatment, although surgical practices remain heterogeneous and the definition of treatment failure lacks standardization [2, 32, 44].

Operative options for chronic lateral ankle instability include anatomic direct repair, anatomic reconstruction with autograft or allograft, and arthroscopic repair [151]. Symptomatic cases can be successfully managed with surgical reconstruction [6]. Arthroscopic techniques are emerging as a potential gold standard, allowing for the treatment of instability and associated intra-articular pathology in a single procedure [78]. Specific arthroscopic approaches, such as the Broström procedure or all-inside ATFL repair, have demonstrated high clinical success rates and resumed ankle stability [39, 12]. Additional inferior extensor retinaculum augmentation is not necessary after all-inside arthroscopic ATFL repair [12]. Ultrasound-guided ATFL repair is also a safe option resulting in clinical improvement at six months [22]. For severe cases, lateral ligament reconstruction with allograft is a valid treatment option leading to satisfying outcomes [33]. Although only fair-quality evidence supports open operative treatment, systematic review data reassure clinicians of current practices [11]. Arthroscopic stabilization also yields significant functional outcomes in patients with medial ankle osteoarthritis [67]. Further evaluation is required to better determine indications for repair versus reconstruction and to establish long-term outcomes [65].

Anatomy & Pathophysiology

Bony Anatomy

The ankle mortise is formed by the tibial plafond, medial malleolus, and lateral malleolus, which articulate with the dome of the talar body [83]. The talar dome is wider anteriorly and narrower posteriorly; consequently, the ankle mortise widens and the joint becomes more stable in dorsiflexion [83]. During motion from plantar flexion to dorsiflexion, the mortise widens 1 to 1.5 mm, while medial and superior clear spaces appear wider with the foot in plantar flexion [83]. The distal tibiofibular joint consists of the convex medial surface of the distal fibula and the concave incisura fibularis of the distal lateral tibia [83]. The fibula rotates approximately 2 degrees within the incisura during ankle motion and ambulation, with dorsiflexion resulting in external rotation and proximal translation of the fibula [83].

The ankle joint is responsible for most sagittal plane motion of the foot and ankle, providing 23 to 48 degrees of plantar flexion and 10 to 23 degrees of dorsiflexion, while also contributing to inversion, eversion, and rotation [83]. Three-dimensional talar shape is not a factor in chronic mechanical ankle instability; rather, dynamic congruency of the joint, influenced by ligamentous integrity, is the main anatomical component in mechanical ankle instability [87].

Ligamentous Anatomy

The lateral ankle ligaments function as restraints to varus and inversion forces at the ankle [83]. The anterior talofibular ligament (ATFL) originates from the anteroinferior aspect of the lateral malleolus, 1 cm proximal to its tip, and extends to the lateral aspect of the talar neck [83]. The calcaneofibular ligament (CFL) extends from the tip of the lateral malleolus to the lateral aspect of the calcaneus, contributing to both ankle and subtalar stability [83, 73]. The posterior talofibular ligament (PTFL) extends from the posterior lateral malleolus to the posterolateral talus [83]. The ATFL is the weakest ankle ligament, while the PTFL is the strongest [83]. The distal tibiofibular joint and fibula provide stability against lateral talar translation [83].

The deltoid ligament complex is the primary ankle stabilizer during stance [83]. It consists of superficial and deep layers, with the deep portion being the primary medial stabilizer of the ankle joint [91]. The deep deltoid ligament extends from the apex of the medial malleolus to the medial talar body and functions primarily to resist lateral talar translation and external rotation [83]. It is organized into two short, thick, discrete bands: the anterior and posterior deep tibiotalar ligaments [91]. The posterior deep deltoid is the most important component of the deep deltoid ligament [83], and the deep posterior tibiotalar ligament is the strongest component of the deltoid complex [91]. The deep deltoid ligament has the highest load to failure at 713.8 N ± 69.3 compared with the lateral collateral ligaments [91]. The dominant mode of failure for the deep deltoid ligament is an intrasubstance rupture near its talar insertion, whereas the dominant mode of failure for the superficial deltoid ligament is at its insertion on the anterior malleolus [91]. The superficial deltoid ligament extends from the distal medial malleolus to the navicular bone, sustentaculum tali of calcaneus, medial talus, and spring ligament, functioning primarily to resist valgus and eversion ankle forces [83]. Subtalar instability is difficult to directly differentiate from ankle instability because the CFL contributes to the stability of both joints [73].

Pathophysiology of Chronic Ankle Instability

Chronic ankle instability is a multifactorial condition involving mechanical and functional insufficiencies resulting from primary ankle sprain [16]. Persistent pain, recurrent sprains, and repeated instances of the ankle giving way are the hallmarks of this condition [16]. Deformities such as hindfoot varus, first ray plantar flexion, midfoot cavus, and generalized laxity play a role in the predisposition to lateral ankle sprain [16]. Lateral ankle sprains occur with an inversion force to the ankle and result in partial or complete tearing of the lateral ankle ligaments [26]. The ATFL is most commonly involved in isolation, followed by a combined injury to the ATFL and CFL [26]. Approximately 10% to 20% of patients with lateral ankle sprains go on to have chronic ankle instability [26], and approximately 30% of those suffering an initial lateral ankle sprain develop chronic ankle instability or repetitive giving way of the ankle during functional activities [144].

The development of chronic lateral ankle instability can involve abnormal neuromuscular response, proprioception, abnormal gait mechanics, global ligamentous laxity, increased body weight, and anatomic features such as cavus alignment and hindfoot stiffness [26]. Mechanical instability is most commonly associated with pathologic joint laxity, while functional instability is typically ascribed to sensorimotor deficits [144]. The pathomechanics of chronic ankle instability are caused by mechanical instability due to ligamentous laxity and functional instability due to deficits in proprioceptive control [148]. The ATFL is the most frequently injured ligament of the ankle, resulting in increased pain and swelling as well as a reduction in dorsiflexion range of motion and postural control [148]. Limitation in dorsiflexion range of motion may result from a lack of adequate posterior gliding of the talus [148]. Poor arthrokinematics cause the talus to remain anterior during weight-bearing tasks, increasing loading of the anterior talofibular ligament [148].

Increased eversion to inversion and dorsiflexion to plantar flexion strength ratios, decreased ankle range of motion, and poor postural control are intrinsic risk factors for chronic ankle instability [148]. Weight, body mass index, and stability are risk factors associated with lateral ankle sprains and chronic ankle instability [147]. Valgus rearfoot alignment and poorer dynamic postural control are associated with chronic ankle instability among adolescent athletes [133]. Individuals with chronic ankle instability demonstrate altered lower limb biomechanics, particularly greater ankle inversion angles and reduced ankle eversion moments [86]. Athletes with chronic ankle instability have a relatively inverted ankle, reduced muscle co-contraction, and lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers [112]. Alterations of kinematics in athletes with chronic ankle instability are found not only at the ankle but also at hip joints during side-cutting movements [100].

Individuals with chronic ankle instability demonstrate dynamic stability deficits, and the direction of the jump can affect dynamic postural stability in the sagittal and frontal planes [138]. The injured and uninjured sides of individuals with unilateral chronic ankle instability demonstrate biomechanical characteristics associated with increased risk of ankle sprain [90]. Chronic ankle instability induces ankle sensorimotor dysfunction, with the number of mechanoreceptors negatively correlated with this dysfunction [46]. Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions [10]. Patients with chronic ankle instability had longer electromechanical delay times in neutral but not when the ankle was placed in inversion [64]. Chronic ankle instability alters central organization of movement, suggesting that treatment may need to account for alterations in brain activity in addition to deficits in the mechanical restraint of the joint [145, 129]. Increased fear of movement is associated with increased ankle joint position sense errors and postural sway in individuals with functional ankle instability [114].

The CAI, coper, and control groups displayed different ankle joint coupling patterns and coordination variability during a walking gait cycle [117]. Dynamic balance deficits in individuals with chronic ankle instability are attested to by reduced sagittal plane motions at the hip, knee, and ankle joints, and reduced capacity of the stance limb to avail of its supporting base [106]. Significant differences between players with and without chronic ankle instability are seen in the support leg kinematics at flat-foot contact with the ground during the kicking cycle [115]. The presence of chronic ankle instability negatively affected ankle function and health-related quality of life in adolescent athletes [131]. Subtalar instability may coexist with ankle instability [73]. Ankle effusion may be present in chronic instability because of synovitis or from an associated osteochondral lesion or loose body [26].

Classification

Pathophysiology: The combination of mechanical and functional insufficiencies resulting from primary ankle sprain are major factors in chronic ankle instability [16]. Deformity, including hindfoot varus, first ray plantar flexion, midfoot cavus, and generalized laxity, plays a role in the predisposition to lateral ankle sprain [16].

Clinical Presentation: Chronic lateral ankle instability is frequently encountered in military service members [3]. Patients with chronic ankle instability demonstrate atrophy of intrinsic and extrinsic foot and ankle musculature accompanied by lower ankle strength [17]. Individuals with chronic ankle instability experience impaired proprioception compared to healthy individuals [62], yet show no notable differences in key muscle activation patterns compared to healthy controls [62]. Only subjects with chronic ankle instability had reductions in self-reported function when compared to ankle sprain copers and healthy individuals [4].

Diagnostic Findings: Preoperative ankle arthroscopy revealed abnormalities of different structures involved in chronic ankle instability with no single causal entity [29]. Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain [165]. The final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle [34].

Clinical Presentation

Symptoms and History

Patients with chronic ankle instability present with a sensation of instability, frequently accompanied by recurrent inversion injuries [26]. Symptoms typically manifest during walking on uneven ground or participation in athletic activity [26]. Only subjects with chronic ankle instability demonstrate reductions in self-reported function compared to ankle sprain copers and healthy individuals [4]. Decreased perceived ankle and knee joint health is associated with increased symptomology in individuals with perceived chronic ankle instability [25]. Intra-articular pathological findings are observed in patients with anterolateral pain after an ankle sprain despite no demonstrable abnormal lateral laxity [58]. A symptomatic peroneus quartus muscle should be considered in athletes with chronic ankle pain, swelling, and instability [107].

Physical Examination

Clinical examination findings in chronic ankle instability may be more subtle than in acute injuries, with minimal ecchymosis and swelling limited to the joint line suggestive of an effusion [16]. Ligament laxity is more easily noted in the patient with chronic instability because the limb tends to be less painful [16]. An ankle effusion may be present due to chronic instability and synovitis or from an associated osteochondral lesion or loose body [26]. Anterior drawer testing and talar tilt stress are performed to evaluate competency of the anterior talofibular ligament and calcaneofibular ligament, respectively [26]. Patients with chronic ankle instability should be assessed for evidence of global ligamentous laxity and weight-bearing hindfoot alignment [26]. Assessment for recurrent instability requires evaluation for hindfoot varus [74]. Patients should be questioned about symptoms of a loose body or osteochondral injury, such as mechanical symptoms like locking or catching [74]. Chronic ankle joint instability induces ankle sensorimotor dysfunction, with the number of mechanoreceptors negatively correlated with this dysfunction [46].

Imaging and Diagnostic Testing

Magnetic resonance imaging evaluation can be useful in demonstrating associated causes of ankle pain, such as chondral injury, bone bruising, radiographically occult fractures, sinus tarsi injury, periarticular tendon tears, degeneration, and impingement syndrome [16]. The cardinal signs of ligament injury on magnetic resonance imaging scans are ligament swelling, discontinuity, a lax or wavy ligament, and nonvisualization [16]. MRI is useful in evaluating for associated pathology to the peroneal tendons or talar articular surface [26]. Although MRI will confirm the abnormal appearance of affected ligaments which may be thickened or indistinct, it does not help determine functional instability [26]. AP, mortise, and lateral weight-bearing radiographs of the ankle are performed in the assessment of chronic ankle instability [26]. Stress radiographs can be used to confirm instability, with a lateral radiograph obtained while performing the anterior drawer test and a mortise radiograph while performing the talar tilt test [26]. Arthroscopy plays a crucial role in the definitive assessment of ligament lesions in patients with chronic ankle instability, supplying far more accurate information than any of the current imaging studies [20]. Preoperative ankle arthroscopy reveals an essential amount of information that would otherwise have been undetected, showing that abnormalities of different structures are involved in chronic ankle instability with no single causal entity [29]. An arthroscopic classification of chronic anterior talofibular ligament lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with chronic ankle instability [42]. The sensitivity of MRI may not be adequate to detect lesions in patients with chronic ankle instability before surgery [54]. In a symptomatic patient, negative results on MRI must be viewed with caution and an arthroscopy may still be required for a definitive diagnosis and treatment [54]. The load–displacement ratio measured via digital arthrometer is a reliable and promising approach for chronic ankle instability diagnosis [27]. A new comprehensive stress radiographic technique might be a reliable and representable measurement tool to assess additional injury or instability of the subtalar joint in chronic lateral ankle instability [45]. Antero-lateral ankle impingement syndrome is closely linked to anterior talo-fibular ligament injury and, in some patients, to chronic ankle instability [59]. Anterolateral soft-tissue impingement is a common cause of chronic pain after one or more lateral ankle sprains and is characterized by hypertrophic synovium, inflamed/enlarged capsular tissues, and scarring [150]. Conventional MRI has a reported sensitivity and specificity of less than 50% for anterolateral soft-tissue impingement of the ankle [150]. A physical examination test specific for anterolateral soft-tissue impingement involves reproduction of the pain with plantar flexion of the ankle, followed by thumb pressure at the anterolateral ankle joint, and dorsiflexion of the ankle [150].

Risk Factors and Associated Pathology

The development of chronic lateral ankle instability is multifactorial and can involve a patient’s abnormal neuromuscular response and proprioception, abnormal gait mechanics, global ligamentous laxity, increased body weight, and anatomic features of the hindfoot and ankle including cavus alignment and hindfoot stiffness [26]. Deformity such as hindfoot varus, first ray plantar flexion, midfoot cavus, and generalized laxity plays a role in the predisposition to lateral ankle sprain [16]. Residual ankle symptoms were found in 33 per cent of patients following acute ankle sprains, and persistent abnormal changes of the ankle were found in 60 per cent [15]. Ligamentous posttraumatic ankle osteoarthritis can develop following ligamentous lesions, with a latency time defined as the span between the initial sprain and the first arthritis consultation [18]. Joint degeneration is demonstrated in young adults with chronic ankle instability [25].

Investigations

Clinical Examination and Physical Testing

Physical examination begins with anterior drawer testing and talar tilt stress to evaluate the competency of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), respectively [26]. An ankle effusion may be present due to chronic instability and synovitis, or from an associated osteochondral lesion or loose body [26]. The load–displacement ratio measured via digital arthrometer is a reliable and promising approach for the diagnosis of chronic ankle instability [27]. A comprehensive stress radiographic technique may serve as a reliable and representable measurement tool to assess additional injury or instability of the subtalar joint [45]. Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions during the transition from double-leg to single-leg stance [10]. Increased symptomology associated with decreased ankle joint health supports information demonstrating joint degeneration in young adults with chronic ankle instability [25].

Imaging

Plain radiography: AP, mortise, and lateral weight-bearing radiographs of the ankle are performed in the evaluation of chronic ankle instability [26]. Stress radiographs confirm instability by obtaining a lateral radiograph while performing the anterior drawer test and a mortise radiograph while performing the talar tilt test [26].

MRI: Magnetic resonance imaging is useful in evaluating for associated pathology to the peroneal tendons or talar articular surface [26]. MRI confirms the abnormal appearance of affected ligaments, which may be thickened or indistinct, but does not help determine functional instability [26]. MRI has excellent interobserver reliability (intraclass correlation coefficient, 0.915) for detecting ATFL injuries in patients with a clinical suspicion of chronic lateral ankle instability [139]. Preoperative MRI is a helpful tool for evaluation but is not sufficient to detect all associated lesions in patients with chronic ankle instability [164]. Isolated injury to the superior fascicle of the lateral ligaments identified on 3D volumetric MRI may be useful when diagnosing patients presenting with symptoms of subtle instability without overt ankle laxity on clinical examination [166]. About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement [157]. MRI detected a posterior syndesmosis injury in 93.5% of patients acutely but became less reliable with time [160].

Arthroscopy

Arthroscopy remains the gold standard in the diagnosis of associated lesions in patients with chronic ankle instability [164]. It plays a crucial role in the definitive assessment of ligament lesions, supplying far more accurate information than current imaging studies [20]. Preoperative ankle arthroscopy reveals essential information that would otherwise have been undetected, showing that abnormalities of different structures are involved in chronic ankle instability with no single causal entity [29]. An arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments and is helpful for determining the best surgical technique for stabilising the ankle [42]. Ankle arthroscopy was performed more frequently in female patients and most commonly in patients younger than 50 years, with a significant increase in its use for lateral ankle instability management [19].

Treatment

Non-Operative

Conservative management for chronic ankle instability prioritizes functional rehabilitation, specifically peroneal strengthening and proprioceptive training [26]. Neuromuscular training paired with functional bracing reduces the recurrence risk of low ankle sprains more effectively than neuromuscular training alone [74]. Additional nonoperative modalities include bracing and the use of orthotics with a lateral-based wedge, particularly in patients with hindfoot varus alignment [26]. A supervised impairment-based program has demonstrated superiority over control groups, with effect sizes exceeding the minimal clinically important difference [50]. Manual therapy techniques, including high-velocity low-amplitude thrusts and mobilization with movement (MWM), reduce pain and improve functional performance [113]. MWM provides sensory input to enhance muscle activation; six sessions improve dorsiflexion range of motion, postural control, and self-reported instability [113]. Adding MWM to a strengthening protocol yields better dorsiflexion and functional outcomes than strengthening alone [113]. Conservative treatment involving rehabilitation, taping, and bracing may reduce recurrent sprains and manage chronic instability [54]. However, appropriate nonoperative treatment should be attempted initially, with surgical management warranted when conservative measures fail to prevent long-term sequelae [3]. The primary indication for surgery is the failure of nonsurgical management [16], and therapeutic strategies prioritize conservative management of proprioceptive deficits before considering surgical repair or reconstruction [14].

Operative

Indications: Surgical intervention is indicated when nonoperative treatment fails to prevent long-term sequelae [3]. The primary indication for surgery is the failure of nonsurgical management [16]. Malalignment associated with chronic lateral ankle instability must be corrected when considering lateral ligament stabilization [73]. Operative procedures focusing on only part of the pathology should be approached with caution until a complete assessment defines all deficiencies [43].

Surgical Approach / Technique: The most commonly used anatomic repair is the Gould modification of the Broström repair [26]. This procedure involves imbrication of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), with additional reinforcement using the lateral talocalcaneal ligament and inferior extensor retinaculum [26]. Anatomic procedures closely recreate native anatomy and preserve motion at the ankle and subtalar joints [26]. Numerous studies report greater than 85% excellent results using anatomic repairs at short-, intermediate-, and long-term follow-up [26]. Anatomic stabilization techniques provide superior functional outcomes compared to non-anatomic techniques [68]. Nonanatomic tenodesis procedures may provide additional stability in high-risk patients, such as those with ligamentous laxity, obesity, or prior stabilization procedures [26]. Surgical treatment involves reconstruction of the lateral ligaments using various anatomic and nonanatomic techniques [26]. Reconstruction of the lateral ankle ligament is a relatively stable treatment option [126]. Although only fair-quality evidence supports open operative treatment, systematic reviews reassure clinicians of current practices [11].

Implant Selection: In patients whose prior surgery failed, those with generalized ligamentous laxity, or those with high functional demands, a tendon graft should be considered to supplement repair [73]. Lateral ligament reconstruction with allograft is a valid treatment option for severe chronic lateral ankle instability, leading to satisfying outcomes and reduced joint morbidity [33]. Allograft tendon reconstruction of the ATFL and CFL increases ankle stability in clinical and functional outcomes [31]. Salvage reconstruction using tendon allograft results in a stable, painless ankle with no additional instability 14 years post-procedure [21]. The application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appears safe and effective [69]. Arthroscopic-assisted mini-open anatomic reconstruction using autologous tendon has been evaluated for its effect on functional recovery [105].

Alignment / Balancing Strategy: Malalignment associated with chronic lateral ankle instability must be corrected when considering a lateral ligament stabilization [73].

Other Considerations: Symptomatic chronic lateral ankle instability can be successfully managed with surgical reconstruction methods [6]. All-inside arthroscopic ATFL repair improves clinical and radiologic outcomes [12]. Additional inferior extensor retinaculum augmentation after all-inside arthroscopic ATFL repair is not necessary [12]. Chronic ankle instability with poor remnant ligament-tissue quality can be treated by arthroscopic all-inside repair and suture augmentation [49]. Open and arthroscopic ATFL repairs equally achieve statistically significant improvement in functional outcome and address functional and mechanical instability [72]. Both Ahlgren-Larsson and arthroscopic methods are safe and effective for chronic lateral ankle instability [109]. Two postoperative treatments differing by weightbearing status after the modified Brostrom procedure show good clinical results and similar outcomes [48]. A new arthroscopic Broström procedure results in a high clinical success rate with resumed ankle stability [39]. A four-step approach provides a suitable minimally invasive method for mild to moderate ankle instability with long-term functional outcomes [47]. Repair of only the ATFL results in similar outcomes to repair of both the ATFL and CFL [13]. The effect of lateral ligament augmentation using suture-tape on functional instability has been studied [13]. A randomized comparison between suture-tape augmentation and modified Broström repair was performed in young female patients [13]. The modified Broström procedure is superior to conservative treatment regarding muscle endurance and postural stability [13]. Simultaneous ossicle resection and lateral ligament repair provide excellent clinical results with early return to activity in pediatric and adolescent patients with os subfibulare [13]. The effect of ossicle resection in lateral ligament repair has been evaluated [13]. Predictors of peroneal pathology in Broström-Gould reconstruction have been identified [13]. Twenty-six-year results after the Broström procedure have been reported [13]. Qualitative and quantitative anatomic investigation of lateral ankle ligaments has been performed for surgical reconstruction [13]. Anatomic reconstruction of the ATFL and CFL using semitendinosus tendon allograft and interference screws has been described [13]. Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability has been described [13]. Critical evaluation of outcome scales for lateral ankle ligament reconstruction has been performed [13]. The role of CFL injury in ankle instability has implications for surgical management [13]. Morphological characteristics of os subfibulare are related to failure of conservative treatment [13]. Deltoid ligament abnormalities in chronic lateral ankle instability have been identified [13]. Acute and chronic lateral ankle instability in the athlete has been reviewed [13]. Operative management includes reconstruction with open and percutaneous methods [13]. Radiographic identification of primary lateral ankle structures has been described [13]. Repair of acute superficial deltoid complex avulsion during ankle fracture fixation in National Football League players has been reported [13]. An acute lateral ankle sprain significantly decreases physical activity across the lifespan [13]. Subtalar instability diagnosis and treatment has been reviewed [13]. Ankle fracture syndesmosis fixation and management reflects current orthopedic practice [13]. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures has been compared [13].

Magnetic resonance imaging (MRI) and stress radiography have been evaluated in chronic lateral ankle instability [23]. The use of MRI in pre-operative evaluation of the ATFL has been described [23]. Associations between MRI findings and symptoms in patients with chronic ankle sprain have been identified [23]. Imaging evaluation of traumatic ligamentous injuries of the ankle and foot has been reviewed [23]. Technical considerations for best practices in MR imaging of the foot and ankle have been outlined [23]. Diagnosis of plantar plate injury by MRI with reference to intraoperative findings has been described [23]. CT and MR imaging of the postoperative ankle and foot has been reviewed [23]. Musculotendinous MRI of the ankle has been discussed [23]. Diagnostic characteristics of standard radiographs and MRI for ruptures of the tibialis posterior tendon have been described [23]. MRI evaluation of anterolateral soft tissue impingement of the ankle has been performed [23]. 3-Tesla MRI evaluation of posterior tibial tendon dysfunction with relevance to clinical staging has been described [23]. Tibiofibular syndesmotic ligaments have been evaluated using MR arthrography in cadavers with anatomic correlation [23]. MRI of sports injuries involving the ankle has been reviewed [23]. MRI features of osteochondral lesions of the talus have been described [23]. Chronic Achilles tendon ruptures have been reviewed [23]. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle has been evaluated [23].

Combined treatment of chronic ankle instability and anterior ankle impingement produces satisfactory surgical outcomes [8]. Arthroscopic Broström technique has been described [13]. Anatomic ligament repairs of syndesmotic injuries have been described [13]. Medial ankle instability: the deltoid dilemma has been reviewed [13]. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains has been described [13]. Ankle instability has been reviewed [13]. Gravity stress radiographs and the effect of ankle position on deltoid ligament integrity and medial clear space measurements have been evaluated [13]. Subtalar instability has been reviewed [13]. Ankle arthroscopy: outcome in 79 consecutive patients has been reported [28]. Complications of ankle arthroscopy have been reviewed [28]. Thermal-assisted capsular modification for functional ankle instability has been described [28]. Peripheral talar fractures have been reviewed [28]. Arthroscopy of the ankle: analysis of results and indications on a series of 75 cases has been reported [28]. Arthroscopic arthrodesis of the ankle joint has been described [28]. Technique and clinical evaluation of arthroscopic ankle arthrodesis has been reported [28]. Complications following arthroscopic ankle arthrodesis have been reviewed [28]. Treatment of posttraumatic adhesive capsulitis of the ankle: a case series has been reported [28]. Anterolateral impingement of the ankle: effectiveness of MR imaging has been evaluated [28]. Progress in ankle arthroscopy has been reviewed [28]. Neurological complications of ankle arthroscopy have been reviewed [28]. Long-term results of arthroscopic ankle arthrodesis have been reported [28]. Ankle arthrodesis using an arthroscopic method: long-term follow-up of 34 cases has been reported [28]. Arthroscopic visualization of the tibial plafond during posterior malleolar fracture fixation has been described [28]. Arthroscopy-assisted reduction and percutaneous fixation of triplane fracture of the distal tibia has been described [28]. Arthroscopic findings in ankle ligament reconstruction have been reviewed [28]. Arthroscopic findings associated with the unstable ankle have been reviewed [28]. Arthroscopically assisted reconstruction and percutaneous screw fixation of a pilon tibial fracture has been described [28]. Soft tissue impingement syndrome of the ankle: diagnostic efficacy of MRI and clinical results after arthroscopic treatment has been evaluated [28]. Arthroscopically assisted reduction and fixation of a juvenile Tillaux fracture has been described [28]. Arthroscopic assessment of occult intra-articular injury in acute ankle fractures has been described [28]. Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture has been performed [28]. Diagnosis of anterolateral ankle impingement: comparison between magnetic resonance imaging and clinical examination has been performed [28]. The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes has been described [28]. Ankle arthrodesis: a comparison of an arthroscopic and an open method of treatment has been performed [28]. Open versus arthroscopic ankle arthrodesis: a comparative study has been performed [28]. Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery has been described [28]. Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? has been evaluated [28]. Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes has been reported [28]. Arthroscopy of the subtalar joint: an experimental approach has been described [28]. Anterolateral ankle impingement: MR arthrographic assessment of the anterolateral recess has been evaluated [28]. Treatment of displaced talus fractures: an arthroscopically assisted approach has been described [28]. Arthroscopic management of septic arthritis: stages of infection and results has been reported [28]. Arthroscopically assisted internal fixation of a talus body fracture has been described [28]. Articular lesions in ankles with lateral ligament injury: an arthroscopic study has been reported [28]. Diagnosis of a tear of the tibiofibular syndesmosis: the role of arthroscopy of the ankle has been evaluated [28]. Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures has been described [28]. The role of ankle arthroscopy on the surgical management of ankle fractures has been reviewed [28]. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study has been performed [28]. The anterior ankle impingement syndrome: diagnostic value of oblique radiographs has been evaluated [28]. Arthroscopic treatment of anterior impingement in the ankle has been described [28]. Clinical outcome of the arthroscopic management of sports-related “anterior ankle pain”: a prospective study has been reported [37]. Arthroscopic treatment and prognostic classification of anterior soft tissue impingement of the ankle has been described [37]. Return to training and playing after posterior ankle arthroscopy for posterior impingement in elite professional soccer has been reported [37].

Complications

Surgical Complications

Neurologic: Neurologic complications occur in 10% of patients undergoing arthroscopic ligament repair or reconstruction, manifesting as transient dysesthesia and neuroma [137]. Entrapment of the peroneus tertius, extensor tendons, and the superficial peroneal nerve can occur when tying sutures for the anterior talofibular ligament [137]. In a series of 11 patients undergoing arthroscopic isolated reconstruction of the anterior talofibular ligament with a free ipsilateral gracilis graft, one patient reported transient dysaesthesiae on the dorsolateral aspect of the foot and heel [163].

Wound and Infection: Cutaneous complications and infection occurred in 4.2% of patients undergoing arthroscopic ligament repair or reconstruction, requiring surgical revision [137]. The rate of cutaneous complications in arthroscopic ligament repair or reconstruction was at least half that of open surgery [137].

Overall Rates and Technique: Complication rates for arthroscopic repair or reconstruction of the talofibular ligament ranged between 11.5% and 18% [137]. A systematic review of level IV studies reported a 17% complication rate for arthroscopic Broström techniques [137]. Two-stage arthroscopy was associated with significantly higher complication rates compared with single-stage arthroscopy [137]. Suture anchor fixation was associated with a 29% complication rate compared with 9% for suture fixation in arthroscopic ligament repair or reconstruction [137].

Long-Term Outcomes and Degeneration

Residual ankle symptoms were found in 33% of patients following acute ankle sprains [15]. Persistent abnormal changes of the ankle were found in 60% of patients following acute ankle sprains [15]. Augmented direct anatomical repair and lateral tenodesis for chronic ankle instability did not lead to significant arthritic changes up to 15 years from surgery [66].

Associated Pathology and Diagnostic Findings

Preoperative ankle arthroscopy revealed abnormalities of different structures involved in chronic ankle instability, indicating no single causal entity [29]. Anterolateral impingement is a less frequent finding in chronic lateral ankle instability, presenting with synovitis and fibrosis [137]. Twelve percent of patients with chronic ankle instability have anterior bony impingement [137]. Concomitant syndesmotic instability and chronic medial ankle instability are significantly associated with unsatisfactory outcomes in patients with chronic ankle instability [1].

Recovery

Non-Operative Recovery and Prognosis: Residual ankle symptoms occur in 33 per cent. of patients following acute ankle sprains [15], while persistent abnormal changes of the ankle are found in 60 per cent. of these patients [15]. The prognosis for a simple inversion injury without visible instability is the same as that for a completely unstable ankle treated by primary ligament suture [171]. Several factors predict eventual chronic ankle instability outcome after a first-time lateral ankle sprain, including an inability to complete jumping and landing tasks within 2 weeks [169], poorer dynamic postural control at 6 months [169], and lower self-reported function at 6 months [169]. A supervised impairment-based program after chronic ankle instability is superior to control [50], with an effect size exceeding the minimum clinically important difference [50]. However, follow-up in trials evaluating these supervised programs tends to be short and inconsistent [50].

Operative Recovery and Outcomes: Symptomatic chronic lateral ankle instability can be successfully managed with a surgical reconstruction method described as easy and effective [6]. Combined treatment of chronic ankle instability and anterior ankle impingement produces satisfactory surgical outcomes [8]. Clinical and radiologic outcomes improve after all-inside arthroscopic anterior talofibular ligament repair [12]. Ultrasound-guided anterior talofibular ligament repair with or without augmentation is safe and results in clinical improvement at 6 months [22]. Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular ligament shows increased stability of the ankle in clinical and functional outcomes [31]. Lateral ligament reconstruction with allograft leads to satisfying outcomes and reduced joint morbidity in patients with severe chronic lateral ankle instability [33]. Two postoperative treatments differing by weightbearing status after modified Brostrom procedure show good clinical results [48] and similar outcomes in clinical and radiological parameters [48]. Augmented direct anatomical repair and lateral tenodesis provide satisfying long-term outcomes in terms of subjective and objective parameters up to 15 years from surgery [66] and do not lead to significant arthritic changes up to 15 years from surgery [66]. One year after the procedure, roentgenograms show stable ankles with a full range of motion [82]. Fourteen years post-procedure, a patient maintained a stable, painless ankle with no additional instability following salvage reconstruction using a tendon allograft [21]. The success of lateral ankle instability surgery depends on proper phases of the rehabilitation period [170]. A patient experienced a return to the same level of sports activities and reported no pain on either ankle following simultaneous posterior ankle arthroscopy for bilateral os trigonum fracture [172].

Functional and Physiological Status: Patients with chronic ankle instability demonstrate atrophy of intrinsic and extrinsic foot and ankle musculature [17] and lower ankle strength [17]. The increased symptomology associated with decreased ankle joint health supports information demonstrating joint degeneration in young adults with chronic ankle instability [25].

Evidence Quality and Reporting Gaps: Fair-quality evidence exists in support of open operative treatment of chronic ankle instability [11]. There is a clear deficiency in the literature pertaining to consistent, meaningful postoperative return to sport timeline following lateral ankle ligament repair [173].

Key Evidence

• [L4] Chronic syndesmotic instability and chronic medial ankle instability are significantly associated with unsatisfactory outcomes in patients with chronic ankle instability. [1] (10.1016/j.arthro.2015.02.021)
• [L4] This paper summarizes a consensus on identifying which patients with chronic ankle instability may require surgery, the optimal surgical intervention, and the role of arthroscopic treatment based on available evidence. [2] (10.1016/j.otsr.2013.10.009)
• [L5] Chronic lateral ankle instability is frequently encountered in military service members; appropriate nonoperative treatment should be attempted initially, but surgical management is warranted when nonoperative treatment fails to prevent long-term sequelae. [3] (10.1016/j.csm.2014.06.011)
• [L3] Only subjects with chronic ankle instability had reductions in self-reported function. [4] (10.2519/jospt.2012.3923)
• [L2] This document is a protocol for a randomised controlled trial designed to determine the effects of MWM on anatomical and clinical characteristics of chronic ankle instability, including long-term effectiveness at 12 months. [5] (10.1186/s12891-019-2447-x)
• [L4] Symptomatic chronic lateral ankle instability could be successfully managed with this easy and effective surgical reconstruction method. [6] (10.1016/j.injury.2003.09.035)
• [L3] Combined treatment of chronic ankle instability and anterior ankle impingement produced satisfactory surgical outcomes in patients with CAI accompanied by anterior ankle impingement symptom. [8] (10.1186/s12891-018-2168-6)
• [L4] Arthroscopic diagnosis and treatment of intra-articular lesions associated with chronic lateral ankle instability is a safe and effective method. [9] (10.1177/0363546508319050)
• [L3] Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions. [10] (10.1177/0363546506294470)
• [L2] Although only fair-quality evidence exists in support of open operative treatment of chronic ankle instability, this systematic review helps reassure clinicians of their current practices. [11] (10.1136/jisakos-2018-000265)
• [L3] The clinical and radiologic outcomes of patients with chronic ankle instability improved after all-inside arthroscopic ATFL repair. [12] (10.1177/03635465211008097)
• [Paper] The paper proposes a comprehensive diagnostic approach to identify ligamentous injuries, predisposing factors, and associated lesions in chronic ankle instability, followed by a therapeutic strategy that prioritizes conservative management for proprioceptive deficits before considering surgical repair or reconstruction of collateral ligaments. [14] (10.1016/j.otsr.2010.04.005)
• [L4] Residual ankle symptoms were found in 33 per cent. of the patients, and persistent abnormal changes of the ankle were found in 60 per cent. [15] (10.2106/00004623-195537060-00011)
• [L5] [16] (10.5435/00124635-200810000-00006)
• [L3] Patients with chronic ankle instability demonstrate atrophy of intrinsic and extrinsic foot and ankle musculature accompanied by lower ankle strength. [17] (10.1177/2325967116653719)
• [L4] [18] (10.1177/0363546505281813)
• [L4] Ankle arthroscopy was performed more frequently in female patients and most commonly in patients younger than 50 years, with a significant increase in its use for lateral ankle instability management. [19] (10.1016/j.arthro.2015.01.020)
• [L2] Arthroscopy plays a crucial role in the definitive assessment of ligament lesions in patients with chronic ankle instability, supplying far more accurate information than any of the current imaging studies. [20] (10.1016/j.otsr.2018.09.008)
• [L4] Fourteen years post-procedure, the patient maintained a stable, painless ankle with no additional instability. [21] (10.1097/01.blo.0000092976.12414.b0)
• [L4] Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months. [22] (10.1016/j.jisako.2025.100386)
• [L3] The increased symptomology associated with decreased ankle joint health further supports information demonstrating joint degeneration in young adults with chronic ankle instability. [25] (10.1007/s00167-018-5163-4)
• [L2] The load–displacement ratio would be a reliable and promising approach for chronic ankle instability diagnosis. [27] (10.1186/s13018-022-03177-3)
• [L4] Preoperative ankle arthroscopy revealed an essential amount of information that would otherwise have been undetected, showing that abnormalities of different structures are involved in chronic ankle instability with no single causal entity. [29] (10.1177/03635465020300031601)
• [L1] The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability. [30] (10.1186/1471-2474-8-6)
• [L4] This case series showed increased stability of the ankle in clinical and functional outcomes. [31] (10.1186/s12891-017-1492-6)
• [L4] This survey reflected the heterogeneity of surgical practices in ankle instability and provided indications for areas of research in clinical situations with the least consensus. [32] (10.1177/2325967120s00009)
• [L4] Lateral ligament reconstruction with allograft represents a valid treatment option in patients with severe chronic lateral ankle instability, leading to satisfying outcomes and reduced joint morbidity. [33] (10.1007/s00402-013-1911-6)
• [L4] The final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. [34] (10.1186/1471-2474-12-212)
• [L4] Ankle stability resumed with a high clinical success rate. [39] (10.1186/s13018-023-03789-3)
• [L4] This arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with CAI and is helpful for determining the best surgical technique for stabilising the ankle. [42] (10.1016/j.otsr.2018.09.004)
• [L5] Operative procedures that only focus on part of the pathology should be approached with caution until assessment of a patient with ankle instability defines all deficiencies. [43] (10.2106/jbjs.21.00726)
• [L4] The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. [44] (10.1177/03635465231153165)
• [L2] A new comprehensive stress radiographic technique for diagnosis of chronic lateral ankle instability presented in this study might be a reliable and representable measurement tool to assess additional injury or instability of the subtalar joint. [45] (10.1007/s00167-016-4037-x)
• [L5] The number of mechanoreceptors was negatively correlated with ankle sensorimotor dysfunction. [46] (10.1177/03635465231217490)
• [L4] These findings are of clinical relevance because they provide a suitable minimally invasive method for the treatment of mild to moderate ankle instability. [47] (10.1007/s00167-020-06368-9)
• [L2] Two postoperative treatments differing by weightbearing status after modified Brostrom procedure for chronic lateral ankle instability showed good clinical results and similar outcomes in clinical and radiological outcomes. [48] (10.1016/j.arthro.2017.08.158)
• [L4] Chronic ankle instability with poor remnant ligament-tissue quality can be successfully treated by an arthroscopic all-inside repair and suture augmentation of the ligament. [49] (10.1007/s00167-018-5117-x)
• [L1] Although a supervised impairment-based program after chronic ankle instability was superior to control, followup in the included trials tended to be short and inconsistent, although the effect size exceeded the MCID and so likely would be identified as clinically important by patients. [50] (10.1097/01.blo.0000534691.24149.a2)
• [L4] [54] (10.1007/s00402-011-1421-3)
• [L4] Intra-articular pathological findings are observed in patients with anterolateral pain after an ankle sprain despite no demonstrable abnormal lateral laxity. [58] (10.1007/s00167-014-3454-y)
• [L4] Antero-lateral ankle impingement syndrome is closely linked to anterior talo-fibular ligament injury and, in some patients, to chronic ankle instability. [59] (10.1016/j.otsr.2017.09.004)
• [L3] Individuals with chronic ankle instability experience impaired proprioception compared to healthy individuals, while showing no notable differences in key muscle activation patterns. [62] (10.1186/s12891-025-09212-8)
• [L3] Patients with chronic ankle instability had longer electromechanical delay times in neutral but not when the ankle was placed in inversion. [64] (10.1007/s00167-016-4243-6)
• [L3] Arthroscopic ankle stabilisation repair and reconstruction techniques hold considerable promise but require further evaluation to better determine the indications of repair versus reconstruction and to obtain information on long-term outcomes. [65] (10.1016/j.otsr.2018.09.005)
• [L3] Augmented direct anatomical repair and lateral tenodesis provide satisfying long-term outcomes in terms of subjective and objective parameters up to 15 years from surgery in patients with chronic ankle instability without leading to significant arthritic changes. [66] (10.1007/s00167-018-5244-4)
• [L4] Ligament stabilization with arthroscopic procedures for individuals with chronic ankle instability and medial ankle OA yielded significant functional outcomes with high patient satisfaction, even without radiographic improvement. [67] (10.1007/s00167-020-05845-5)
• [L4] [68] (10.1007/s00167-017-4730-4)
• [L4] In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective. [69] (10.1186/s12891-023-06390-1)
• [L2] Open and arthroscopic ATFL repairs equally achieved statistically significant improvement in functional outcome and effectively addressed functional and mechanical ankle instability. [72] (10.1177/23259671261417357)
• [L5] Arthroscopic treatment of ankle instability is emerging as the potential gold standard technique, offering the advantage of addressing both instability and associated intra-articular pathology in a single procedure with excellent results. [78] (10.1016/j.arthro.2020.10.043)
• [L4] Individuals with CAI demonstrate altered lower limb biomechanics, particularly greater ankle inversion angles and reduced ankle eversion moments, which may increase the risk of recurrent lateral ankle sprains. [86] (10.1186/s12891-026-09968-7)
• [L3] This supports the interpretation that the dynamic congruency of the joint, which is influenced by ligamentous integrity remains the main anatomical component in mechanical ankle instability. [87] (10.1186/s12891-025-09458-2)
• [L3] The study showed that the injured and uninjured sides of CAI demonstrate biomechanical characteristics associated with increased risk of ankle sprain, suggesting that management strategies should target both ankles. [90] (10.1177/23259671251394031)
• [L3] Alterations of kinematics in athletes with chronic ankle instability were found not only at the ankle but also at hip joints during the side-cutting movement. [100] (10.1007/s00167-015-3745-y)
• [L3] [105] (10.1186/s12891-025-09323-2)
• [L3] This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. [106] (10.1007/s00167-015-3744-z)
• [L4] The presence of a symptomatic peroneus quartus muscle should be considered in athletes with chronic ankle pain, swelling, and instability. [107] (10.1177/03635465010290032101)
• [L2] Both Ahlgren-Larsson and arthroscopic methods are safe and effective for chronic lateral ankle instability. [109] (10.1007/s00402-021-03799-y)
• [L3] Athletes with chronic ankle instability had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers, which may jeopardize the stability of the ankle. [112] (10.1177/0363546511406868)
• [L4] Increased fear of movement is associated with increased ankle joint position sense errors and postural sway in individuals with functional ankle instability. [114] (10.3390/ijerph19052792)
• [L4] Significant differences between players with and without CAI were seen in the support leg kinematics at flat-foot contact with the ground during the kicking cycle. [115] (10.1177/23259671221112966)
• [L3] The CAI, coper, and control groups displayed different ankle joint coupling patterns and coordination variability during a walking gait cycle. [117] (10.1177/23259671221139482)
• [L1] Reconstruction of the lateral ankle ligament is a relatively stable treatment for chronic ankle instability. [126] (10.1016/j.injury.2020.05.031)
• [Paper] Treatment of ankle instability in the future may need to account for alterations in brain activity in addition to deficits in the mechanical restraint of the joint provided by the articular, ligamentous, and muscular stabilizers. [129] (10.1097/corr.0000000000002991)
• [L3] The presence of CAI negatively affected ankle function and HRQoL in adolescent athletes. [131] (10.1177/2325967119900962)
• [L3] Valgus rearfoot alignment and poorer dynamic postural control were associated with chronic ankle instability among adolescent athletes. [133] (10.1177/23259671231202220)
• [L3] Athletes with chronic ankle instability demonstrated dynamic stability deficits, and the direction of the jump can affect dynamic postural stability in the sagittal and frontal planes. [138] (10.1186/s12891-025-09307-2)
• [L3] This study showed that MRI has excellent interobserver reliability (intraclass correlation coefficient, 0.915) for detecting ATFL injuries in patients in whom there is a clinical suspicion of chronic lateral ankle instability. [139] (10.1016/j.arthro.2015.02.024)
• [L5] [144] (10.1016/j.csm.2008.03.006)
• [L3] [145] (10.1177/0363546509351562)
• [L1] [147] (10.1136/jisakos-2019-000305)
• [L4] Surgical procedures for managing chronic lateral ankle instability include anatomic direct repair, anatomic reconstruction with an autograft or allograft, and arthroscopic repair. [151] (10.5435/jaaos-d-16-00623)
• [L3] About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement, while more than half had evidence of any lateral ligament injury without syndesmotic involvement. [157] (10.1177/0363546514529643)
• [L3] MRI detected a posterior syndesmosis injury in 93.5% of patients acutely but became less reliable with time. [160] (10.1007/s00167-019-05581-5)
• [Paper] [163] (10.1016/j.injury.2020.03.054)
• [L3] MRI is a helpful tool for preoperative evaluation, but arthroscopy remains gold standard in the diagnosis of associated lesions in patients with CAI. [164] (10.1007/s00167-017-4567-x)
• [L1] [165] (10.1007/s00167-021-06610-y)
• [L3] Isolated injury to the superior fascicle identified on MRI may be useful when diagnosing patients presenting with symptoms of subtle instability without overt ankle laxity on clinical examination. [166] (10.1007/s00167-022-07275-x)
• [L2] An inability to complete jumping and landing tasks within 2 weeks of a first-time lateral ankle sprain and poorer dynamic postural control and lower self-reported function 6 months after a first-time lateral ankle sprain were predictive of eventual chronic ankle instability outcome. [169] (10.1177/0363546516628870)
• [L5] The success of lateral ankle instability surgery also depends on proper phases of the rehabilitation period. [170] (10.1177/2325967124s00376)
• [L4] The prognosis for a simple inversion injury without visible instability is the same as that for a completely unstable ankle treated by primary ligament suture. [171] (10.1007/bf00932312)
• [L5] She experienced a return to the same level of sports activities and reported no pain on either ankle. [172] (10.5435/jaaosglobal-d-23-00237)
• [L4] The review identifies a clear deficiency in the literature pertaining to consistent, meaningful postoperative return to sport timeline following lateral ankle ligament repair. [173] (10.1136/jisakos-2016-000064)

See Also

• Lateral ligament reconstruction
• Ankle osteoarthritis
• Ankle arthroscopy
• Ankle impingement
• Syndesmotic injury
• Ankle fracture fixation
• Ankle fracture
• Ankle arthrodesis

References

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[87] Three-dimensional talar shape seems not a factor in chronic mechanical ankle instability. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-09458-2

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