Many people have successful arthroscopic lateral ligament repair for their ankle instability. For others, there were less than hopes for results. Continued ankle instability after arthroscopic lateral ligament repair can be caused by many factors. Among them is generalized joint laxity or joint hypermobility found in people suffering from disorders like Ehlers-Danlos syndrome. It can also be caused by general overuse and high-level sporting activities. It can also be caused by the repaired ligaments not being strong enough to hold the repair. Further, the ankle may be suffering from instability from the other ankle joints.
A July 2025 study (1) found that despite arthroscopic lateral ankle ligament repair gaining in popularity for chronic lateral ankle instability and with several studies having reported excellent outcomes with this procedure, the effect of age however, on clinical outcomes, remains unclear. This study aimed to analyze the effect of age on the clinical outcomes of arthroscopic repair for chronic lateral ankle instability.
- Seventy‐five ankles of 69 patients (age average 35.6 years) who underwent arthroscopic anterior talofibular ligament (ATFL) repair with calcaneofibular ligament (CFL) repair for chronic lateral ankle instability between February 2019 and December 2023 were reviewed.
- The mean follow‐up period was on average 15.3 months.
- Nineteen ankles exhibited recurrent instability (25.3%); however, no ankles required revision surgery.
- Pain, disability and function scores were lower in the older patients in this study.
- The researchers found: “Increasing age negatively affects the clinical outcomes of arthroscopic repair for chronic lateral ankle instability due to residual pain and poor mental health.”
Continued ankle instability after arthroscopic lateral ligament repair
A November 2025 study (2) writes that despite good clinical outcomes following arthroscopic lateral ligament repair, some patients show residual or recurrent instability after surgery. Although some risk factors of recurrent instability have been reported, characteristic patterns of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injuries may be observed in patients with chronic lateral ankle instability who have residual instability after isolated ATFL repair or recurrent instability after arthroscopic lateral ligament repair.
- The study reviewed 27 patients with chronic lateral ankle instability and 10 controls without chronic lateral ankle instability who underwent arthroscopic surgery.
- The researchers found calcaneofibular ligament was injured and shifted medially in patients with residual ankle instability.
- Further, the anterior talofibular ligament (ATFL) in patients with recurrent instability showed talar side drooping.
- These findings suggest that additional surgery for calcaneofibular ligament repair or anterior talofibular ligament augmentation may be beneficial in preventing recurrent instability after arthroscopic repair.
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References
1 Brilianto BI, Nakasa T, Ikuta Y, Kawabata S, Moriwaki D, Sakurai S, Ishibashi S, Adachi N. Negative impact of increasing age on clinical outcomes of arthroscopic lateral ankle ligament repair for chronic lateral ankle instability. Journal of Experimental Orthopaedics. 2025 Jul;12(3):e70328.
2 Sakurai S, Nakasa T, Ikuta Y, Kawabata S, Moriwaki D, Ishibashi S, Brilianto BI, Adachi N. Morphological Characteristics of Lateral Ankle Ligament Injuries Associated With Recurrent Instability After Arthroscopic Repair for Chronic Ankle Instability: 3D Volume Rendering MRI Model Analysis. Orthopaedic Journal of Sports Medicine. 2025 Nov;13(11):23259671251387340.