What are the indications surgical intervention to treat ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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In most patients, operative repair of third-degree ATFL tears and medial ankle ligament tears does not contribute to an improved outcome. One of the few absolute indications for surgery in patients with a sprained ankle is a distal talofibular ligament third-degree sprain that causes widening of the ankle mortise. A second indication for surgical treatment of acute ankle sprains is a deltoid sprain with the deltoid ligament caught intra-articularly and with widening of the medial ankle mortise. In selected young patients with high athletic demands who have both anterior talofibular and calcaneofibular complete ruptures, surgical repair may be the treatment of choice. Further research is needed to determine the best treatment for complete double-ligament lateral ankle sprains.

Surgical procedures for chronic ankle instability and sprains vary greatly in their ability to correct subtalar instability. A review of the literature showed the Watson-Jones procedure to be associated with subjective instability 20-90% of the time, and the Evans procedure, 20-33%. In addition, with the Evans procedure, a persistent anterior drawer sign was found in 45-60% of patients. In the Chrisman-Snook procedure, 13-30% of patients had subjective persistent instability. Decreased inversion is common with all these procedures.

For more information, see Surgical Interventions in Ankle Sprain.

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