Reconstruction of Lateral Ankle Ligaments Update

Lateral ligament insufficiency secondary to ankle sprain is one of the most frequently encountered musculoskeletal injuries. Such an insult typically occurs following a combined inversion-plantar flexion injury of the foot, which often leads to disruption of the lateral ligamentous complex. While most fully recover, up to 20% of patients experience long-lasting symptoms following the initial event, such as stiffness, ligament laxity, weakness, and recurrent sprains– all of which pave the way for chronic ankle instability. Left unaddressed, lack of joint stability can initiate a cascade of undesirable complications, such as chronic pain, synovitis, chondral damage, and osteoarthritis. Treatment with conservative modalities, such as functional rehabilitation, muscle strengthening, and proprioceptive training, is often successful, particularly in cases of functional instability alone (subjective feeling of one’s ankle “giving out”). For patients that develop chronic instability and fail to achieve satisfactory outcomes with a conservative treatment regimen, surgical intervention is often indicated.

Anatomically, chronic lateral ankle instability is often due to compromise of the anterior joint capsule and the anterior talofibular ligament (ATFL), with additional insufficiency of the calcaneofibular ligament (CFL) in about 15%-30% of patients. Ligamentous repair of the lateral ankle is typically classified as non-anatomic or anatomic. While non-anatomic procedures usually achieve successful reconstruction outcomes, these techniques have been linked to abundance of undesirable post-surgical complications; as such, anatomic reconstruction, in particular the modified Brostrom-Gould method is considered by many orthopedic surgeons to be the superior reconstructive technique for repair of the aforementioned ligaments. 

Yet while the modified Brostrom has proven both reliable and highly effective, clinical studies show that anywhere from 13% to 35% of patients experience residual symptoms following successful anatomic reconstruction as a result of unaddressed intra-articular lesions.