J Korean Foot Ankle Soc.  2020 Mar;24(1):1-8. 10.14193/jkfas.2020.24.1.1.

Chronic Lateral Ankle Instability

  • 1Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea


Acute ankle sprain is the most common injury in the lower extremities, and approximately 10% to 40% of acute lateral ankle ligament injury causes chronic pain or instability. For chronic symptoms lasting after an acute sprain, the possibility of joint damage, such as bony structures, ligaments, cartilage, and nerves around the ankle joint, should be considered. Patients with chronic lateral ankle instability usually complain of repeated sprains or giving way sensations. There has been steady progress in the treatment options until recently, however new treatments are still being attempted. This paper describes the causes, diagnosis, and recent trends in the conservative and operative treatment of chronic lateral ankle instability.


Ankle; Lateral; Instability


  • Figure 1. Lateral fibulotalocalcaneal ligament complex has variable connections between anterior talofibular ligament superior fascicle (ATFLsf), ATFL inferior fascicle (ATFLif), CFL, and PTFL. CFL: calcaneofibular ligament, PTFL: posterior talofibular ligament.

  • Figure 2. Standing anteroposterior radiograph of 50-year-old male patient showed varus arthritis of left ankle which might be caused by chronic lateral instability (A). Abnormal talar tilt (14 degrees) was seen on his varus stress radiograph (B).

  • Figure 3. Anterior bony spur was revieled on radiograph of 18-year-old male who complained of impinging pain and subjective instability. And there was no mechanical instability, neither on varus (A) and anterior draw (B) stress radiograph.

  • Figure 4. Classification of operative methods for chronic mechanical instability of the ankle joint.

  • Figure 5. Anatomic repair of anterior talofibular ligament (ATFL). Direct repair of torn ATFL (Broström technique, A) and augmentation with inferior extensor retinaculum (Broström-Gould technique, B).

  • Figure 6. Anatomic reconstruction of lateral ligaments using single fibular bone tunnel (A) and double tunnels (B).



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