Treatment of chronic instability of the ankle joint caused by lateral ligament complex trauma: review

Abstract

Background. The incidence of injuries to the lateral ligaments of the ankle joint is up to 22% of all sports injuries and 85% of all ankle sprains. Most of these are effectively managed using nonoperative measures in the acute setting. Approximately 20% of patients will, however, develop chronic lateral ankle instability. A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. The aim is to evaluate treatment options for chronic ankle instability and determine the state of the problem of current methods of treatment. Material and methods. For the analysis of the literature, 100 foreign articles were selected on chronic instability of the ankle joint and methods of its treatment, published from 1985 to 2023, as well as 18 domestic publications for the period from 2007 to 2022. 59 most relevant articles were selected. Publications were searched in the PubMed/MedLine and eLIBRARY databases. Results. Recent and remote literature agrees that the initial treatment for chronic lateral ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high body mass index, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Conclusion. There is limited evidence to support any particular surgical technique over another surgical technique for chronic lateral ankle instability. The open modified Brostrom-Gould collateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ankle instability. Nonanatomic reconstruction abnormally increases inversion stiffness at the subtalar level compared with anatomic reconstruction and shows greater clinical dissatisfaction. Arthroscopic repair can reduce recovery time and improve outcomes in certain populations, but there is a higher complication rate with these surgeries. When using new modifications and techniques, long-term outcome studies are needed to determine their long-term usefulness and compare them with the results of open surgery.