For citation purposes: Hong CC, Tan KJ. Concepts of ankle instability: A review. OA Sports Medicine 2014 Feb 22;2(1):3.


Injury & Reconstruction of Ligaments

Concepts of ankle instability: A review.

C Hong, K Tan

Authors affiliations

(1) University Orthopaedic and Reconstructive Microsurgery, National University Hospital of Singapore

(2) Orthosports Clinic for Orthopaedic Surgery and Sports Medicine, Mount Elizabeth Novena Hospital, Singapore

* Corresponding author Email:



Ankle sprains are very common. While most of them recover well, a significant number of patients will progress to develop chronic ankle instability (CAI). CAI encompasses the development of residual symptoms such as chronic pain, swelling and recurrent ankle sprains. We aim to describe the basic anatomy and injuries of the ankle ligaments, different concepts of ankle instability and the therapeutic options including rehabilitation approaches and surgical reconstruction with both open and arthroscopic techniques.


CAI consists of 2 components namely the mechanical and functional instability. Both are treated with rehabilitative strategies initially and surgical treatment is indicated if rehabilitation failed. Anatomic reconstruction is recommended as it preserves the primary ligaments and restores the original mechanical stability. Non-anatomic reconstruction has been described but poor outcomes ensue as it does not replicate the anatomical position of the lateral ligament complex. Anatomic reconstruction with autograft and allograft is used for failed primary repair or when primary ligaments are attenuated. The role of ankle arthroscopy is developing with good results from arthroscopic anatomical repair of the lateral ligament complex. In the recent years, it should be considered as a single surgical intervention to treat both concomitant intra-articular injuries and the primary lateral ligament pathology.


Chronic ankle instability is very common. The mechanical and functional components coexist and it is important to treat both components. Rehabilitative programs should always be first line treatment followed by surgical reconstruction for mechanical instability. Arthroscopic technique allows simultaneous treatment of concomitant intra-articular pathologies and provides smaller wounds with potential earlier postoperative rehabilitation.

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