Lateral Ankle Ligament Reconstruction

Indications

Ankle Instability, lateral collateral ligaments of the ankle
Lateral collateral ligaments of the ankle. Image by Laboratoires Servier, Wikimedia Commons, CC BY 4.0.
  • Chronic lateral ankle instability failing rehabilitation
  • Recurrent sprains with giving way despite peroneal strengthening and proprioceptive training
  • Mechanical instability on anterior drawer and talar tilt tests
  • Assess for hindfoot varus, peroneal tears and generalised laxity
  • Stress radiographs or MRI support the diagnosis

Position

  • Supine, bump under the hip, thigh tourniquet
  • Image intensifier for anchor placement

Operative Steps

  1. Curved incision along the anterior fibula
  2. Protect the superficial peroneal and sural nerves
  3. Arthroscopy first to treat intra-articular lesions
  4. Divide and imbricate the ATFL and CFL, or reattach them to the fibula with anchors (Brostrom)
  5. Advance the inferior extensor retinaculum over the repair (Gould)
  6. Tendon graft reconstruction for poor tissue or failed repair
  7. Correct cavovarus with a calcaneal osteotomy if present
  8. Arthroscopic or all inside Brostrom techniques are alternatives

Postoperative Care

  • Boot for about 6 weeks
  • Proprioceptive and peroneal rehabilitation
  • Weight bearing in the boot as comfortable
  • Avoid inversion for 6 weeks
  • Return to sport at 3 to 4 months
  • Brace for sport in the first season

Complications

  • Superficial peroneal and sural nerve injury
  • Stiffness and loss of inversion
  • Recurrent instability
  • Wound breakdown over the lateral malleolus
  • Peroneal tendon irritation
  • Subtalar stiffness after nonanatomic tenodesis such as Evans or Chrisman Snook

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.