Chronic Lateral Ankle Instability in Highly Active Patients: A Treatment Algorithm Based on the Arthroscopic Assessment of the Calcaneofibular Ligament

Background Ankle sprains are common injuries that may recur as chronic conditions. We aim to describe a treatment algorithm for chronic lateral ankle instability based on the arthroscopic findings of the calcaneofibular ligament (CFL). Methods We assessed 67 highly active patients with chronic lateral ankle instability. They were recreational athletes or active military personnel. After clinical examination, they were all investigated further with MRI scans and stress views. Diagnostic arthroscopy followed, where the integrity of the CFL was assessed. Patients with an intact CFL were placed in group A while those with CFL tears in group B. Concomitant intra-articular pathologies, if present, were treated arthroscopically. CFL tears mandated that modified Broström-Gould reconstruction would follow. The American Orthopaedic Foot and Ankle Society (AOFAS) and Tegner scores were noted post-injury and during the 24-month follow-up. Results A total of 37 patients were put in group A and 30 in group B. The posterior talofibular ligament was intact in both groups. Synovitis and scar tissue were more common in group A (p = 0.01) compared to group B. Overall, no postoperative ankle instability or relapsing ankle sprain was documented. Both groups demonstrated significant improvement in their Tegner (p = 0.009) and AOFAS scores (p = 0.001) during their 24 months follow-up. Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). Conclusion Our proposed algorithm offered a reliable pathway for accurate evaluation and successful treatment of chronic lateral ankle instability in high-demand groups.