CHRONIC ANKLE INSTABILITY: A REVIEW OF MODERN APPROACHES TO DIAGNOSIS AND TREATMENT

Abstract

Introduction. Ligamentous injuries of the ankle joint are among the most common sports- and work-related musculoskeletal injuries. Despite advances in the management of acute ankle sprains, 25–40% of patients subsequently develop chronic ankle instability (CAI). This condition is characterized by recurrent ankle sprains, persistent pain, reduced range of motion, and impaired proprioception, resulting in functional limitations and highlighting the need for a well-defined diagnostic and therapeutic approach.Aim. To conduct a comprehensive analysis of current scientific evidence regarding the pathophysiological mechanisms, differential diagnostic criteria, and clinical outcomes of conservative and surgical treatment strategies for patients with chronic post-traumatic ankle instability.Materials and methods. This review analyzes the anatomical and biomechanical characteristics of the lateral ligament complex, including the anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular (PTFL) ligaments. It also examines the physiological basis for classifying CAI into mechanical instability (structural ligament insufficiency) and functional instability (neuromuscular deficits and impaired coordination).Results. Comprehensive clinical evaluation should combine specific manual stress tests with advanced imaging modalities. Ultrasonography and magnetic resonance imaging demonstrate high diagnostic accuracy for assessing ligament integrity and detecting associated intra-articular lesions, including synovitis, osteochondral defects, and impingement syndrome. A differentiated treatment strategy is recommended: structured conservative rehabilitation lasting at least 3 months is effective for patients with functional instability, whereas persistent mechanical instability requires surgical stabilization. Surgical techniques have evolved from the conventional open Broström–Gould procedure to contemporary minimally invasive arthroscopic repair and synthetic tape augmentation.Conclusions. Chronic ankle instability is a multifactorial disorder that requires simultaneous management of both mechanical and functional impairments. Arthroscopic anatomical repair of the lateral ligament complex demonstrates clinical outcomes comparable to those of open surgery while providing the advantages of reduced soft tissue trauma, a lower rate of neurological complications, and faster postoperative rehabilitation.