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J Am Acad Orthop Surg, Vol 16, No 10, October 2008, 608-615.
© 2008 the American Academy of Orthopaedic Surgeons
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Management of Acute and Chronic Ankle Instability

Nicola Maffulli, MD, MS, PhD, FRCS and Nicholas A. Ferran, MBBS, MRCSEd

Dr. Maffulli is Professor, Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom. Mr. Ferran is Research Fellow, Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, United Kingdom.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Maffulli and Mr. Ferran.

Reprint requests: Dr. Maffulli, Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Thornburrow Drive/Hartshill, Stoke-on-Trent, ST4 7QB United Kingdom.

Acute lateral ankle ligament injuries are common. If left untreated, they can result in chronic instability. Nonsurgical measures, including functional rehabilitation, are the management methods of choice for acute injuries, with surgical intervention reserved for high-demand athletes. Chronic lateral ankle instability is multifactorial. Failed nonsurgical management after appropriate rehabilitation is an indication for surgery. Of the many surgical options available, anatomic repair of the anterior talofibular and calcaneofibular ligaments is recommended when the quality of the ruptured ligaments permits. Anatomic reconstruction with autograft or allograft should be performed when the ruptured ligaments are attenuated. Ankle arthroscopy is an important adjunct to ligamentous repair and should be performed at the time of repair to identify and address intra-articular conditions associated with chronic ankle instability. Tenodesis procedures are not recommended because they may disturb ankle and hindfoot biomechanics.






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