Ankle Ligament Injuries: Long-Term Outcomes After Stabilizing Surgery

Chronic lateral ankle instability is a common complaint after lateral ligament injury; developing in approximately 10–30% of all patients who have sustained a ligament injury. Nonsurgical treatment, including strength, agility, and reflex training is usually recommended as the first treatment choice and is considered successful to alleviate symptoms of giving way in approximately half of the patients. However, if this fails, surgical repair or reconstruction is recommended. There are more than 60 different procedures, either direct repair of the ligaments, like the original Brostrom technique, described more than 50 years ago, or more complex procedures. However, anatomical procedures, either direct repair or anatomical reconstruction, e.g., several modified Brostrom procedure techniques, are preferred. Based on current evidence, nonanatomic reconstructions have been shown to abnormally increase inversion stiffness at the subtalar joint compared with the anatomical procedures. As this may lead to an increased risk of degenerative changes or even frank osteoarthritis, these procedures should be avoided as the first-line surgical choice. On the other hand, anatomical repair procedures and anatomical reconstructions more constantly acquire good and excellent clinical results and are therefore appropriate first-line surgical choice.