J Korean Foot Ankle Soc.  2021 Mar;25(1):17-24. 10.14193/jkfas.2021.25.1.17.

Surgical Procedures for Chronic Lateral Ankle Instability

  • 1Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea


Surgical treatments for chronic lateral ankle instability include anatomic repair, anatomic reconstruction using an auto or allograft, nonanatomic reconstruction, and arthroscopic repair. Open anatomic repair using the native ligament with or without reinforcement of the inferior extensor retinaculum is commonly performed in patients with sufficient ligament quality. Non-anatomical reconstruction using the adjacent peroneus brevis tendon is typically used only in patients with poor-quality ligament remnants or when previous repair failed. Anatomical reconstruction can be considered in patients in whom anatomical repair is expected to fail and when performed using auto or allografts can provide good to excellent short-term results, although the long-term outcomes of these methods remain unclear. Arthroscopic repair can provide good to excellent short-term clinical outcomes, but evidence supporting this technique is limited. The advantages and disadvantages of various surgical methods should be compared, and appropriate treatment should be implemented based on patient characteristics.


Ankle; Joints; Surgical procedure


  • Figure. 1 Watson-Jones procedure. Peroneus brevis tendon was released proximally, then rerouted through the distal fibula and fixed to the anterolateral talus.

  • Figure. 2 Evans procedure. Peroneus brevis tendon simply passed anterior to posterior through the distal fibula.

  • Figure. 3 Chrisman–Snook procedure. Splitted peroneus brevis tendon passed anterior to posterior through the distal fibula and then proximal to distal through the lateral calcaneus.

  • Figure. 4 Brostrom procedure. The anterior talofibular ligament and calcaneofibular ligament were direct repaired.

  • Figure. 5 Karlsson procedure. The anterior talofibular ligament and calcaneofibular ligament were anchored to the distal fibula through drill holes.

  • Figure. 6 Modified Brostrom procedure. Direct repair was augmented with inferior extensor retinaculum.

  • Figure. 7 Anatomical reconstruction of anterior talofibular ligament.

  • Figure. 8 Anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament.


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