Ankle Lateral Ligament Instability

An ankle ligament sprain is an extremely common injury, particularly in the younger, athletic population. Instability is caused by inversion type injuries of the ankle commonly referred to as “rolling” the ankle.

At least half of these injuries, if rehabilitated appropriately, go on to have no further problems with ankle sprains or instability. It is important the rehabilitation is started early and adequately supervised by either a doctor or physiotherapist. The rehabilitation program will gradually progress as the ankle becomes stronger and more stable. This also helps to reduce the risk of reinjury.

  • Video:

    Lateral ankle ligament reconstruction

    This procedure is performed to correct chronic ankle instability that has not responded to treatment such as physical therapy. Ankle instability occurs when ligaments are stretched or torn. A simple repair, known as the Bröstrom-Gould technique, is ideal for athletes who need to retain full range of motion.

    Ankle arthroscopy

    This procedure identifies and treats problems in your ankle. With it, the surgeon can access your ankle without creating a large incision.

    Arthroscopic articular cartilage repair

    This minimally-invasive procedure is performed to stimulate the growth of fibrocartilage in an injured joint. Fibrocartilage is a tough, dense, fibrous material that can fill in areas where smooth, glassy cartilage has become damaged or worn away. This procedure may be performed with general or regional anesthesia.

    Occasionally it may lead to ongoing symptoms:

    • Functional instability – the feeling of the ankle giving way during activity
    • Mechanical instability – when patients have excessive ankle motion, more than normal
    • The ankle is supported both in a dynamic and static fashion:
    • Dynamic – via the peroneal longus and brevis tendons
    • Static – via the lateral ligament complex:
    • ATFL: most commonly injured, weakest
    • CFL: intermediate
    • PTFL: strongest, rarely injured

    There are other potential causes or contributing factors which may be related to your symptoms such as tarsal coalition, generalised ligamentous laxity or high arched foot.

    Ultimately the aim is to have the patient return to a normal, active lifestyle.

  • Symptoms:
    • May depend on the specific or associated underlying cause
    • Pain – in the ankle joint if a cartilage injury is present, synovitis of the joint or impingement
    • Swelling
    • Recurrent instability
    • Difficulty walking on uneven ground, difficulty playing sports
    • Clicking or subluxation/dislocation of the peroneal tendons
    • Catching within the joint
  • Natural History:

    Symptoms may wax and wane, or worsen
    If repetitive, there is risk of fracture, cartilage damage or injury to the peroneal tendons
    Eventually ankle joint arthritis may ensue resulting in loss of articular or joint cartilage leading to progressive stiffness/pain/swelling.

  • Imaging:

    Weight-bearing X-rays are required. MRI scans may be required.

  • Non-operative Measures:

    Non-operative Measures:

    • Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
    • Footwear modification: lateral heel wedge, flared sole
    • Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
    • Physiotherapy: strengthening of peroneal tendons, proprioception including wobble board and stretches
    • Weight loss management
    • External lace up ankle brace support or taping
  • Surgery:
    Considered if symptoms are progressing and function is decreasing after a trial of non-surgical treatment. Sometimes these procedures may be combined with other procedures.
    Depending on the extent and nature of disease, surgical options may include:

    • Arthroscopy of the ankle joint +/- treatment of a cartilage lesion
    • Arthroscopic lateral ligament reconstruction
    • Open lateral ligament reconstruction
    • Occasionally these reconstructions will need extra support from a synthetic implant
    • Peroneal tendon reconstruction or repair

Post Operative Guide Further Reading

General info: