[Lateral instability of the ankle joint (1). Non-surgical treatment is the first choice--20 per cent may need ligament surgery].

In cases of lateral ankle injury, although acute ligament ruptures are best treated non-operatively with physiotherapy (range-of-motion and co-ordination training, and peroneal muscle strengthening exercises), about 10-20 per cent of patients nonetheless develop chronic functional instability: While this is not severely disabling, ligament reconstruction may be necessary in specific cases, e g for those with high demands of ankle stability. Of the more than 50 surgical approaches published, several have become classic reconstructive procedures widely used--e g, those of Evans and Watson-Jones (with disappointing long-term results), and that of Chrisman-Snook (with satisfactory long-term outcome). However, anatomical ligament reconstruction (with shortening, re-insertion and imbrication of the healed but elongated ligament) is a simple procedure with good short- and long-term results, which may often be a better alternative than other more complex reconstructive procedures.