Ankle instability: the arthroscopic revolution
Seance of wednesday 22 october 2025 (L'Académie reçoit l'Association Française de la Chirurgie du Pied (AFCP))
DOI number : 10.26299/v1rr-9j30/emem.2025.43.06
Abstract
Introduction
Ankle sprain is a traumatic injury of the lateral ligamentous complex (LLC). It represents the most frequent traumatic pathology of the musculoskeletal system and may progress to chronic ankle instability. This condition is characterized by recurrent sprains, episodes of giving way, or a persistent feeling of insecurity in the joint.
Development
Ankle arthroscopy, first described in the 1980s, was for a long time limited to the treatment of chondral lesions and anterior impingement. Its development was markedly slower compared with knee and shoulder arthroscopy. A turning point occurred in the 2010s with the work of Jordi Vega, surgeon, and Pau Golano, anatomist, who contributed to a better understanding of the LLC. They focused on the lateral recess of the joint, whose floor corresponds to the superior part of the ligament. Their studies demonstrated the continuity of the ligamentous fascicles and made it possible to achieve direct access to the ligament. Based on these anatomical findings, new arthroscopic techniques were developed. When the ligament is present but non-functional (scarred, lax, or detached), arthroscopic repair can be performed. In cases of complete rupture, an anatomical reconstruction using the gracilis tendon is feasible. Arthroscopy also offers the advantage of addressing associated intra-articular lesions, such as cartilage injuries and anterior impingement, during the same procedure.
Conclusion
Arthroscopy has profoundly transformed the management of chronic ankle instability. It allows precise diagnostic assessment, arthroscopic anatomical repair or reconstruction of the ligamentous complex, and simultaneous treatment of associated intra-articular lesions. This evolution constitutes a true therapeutic revolution, providing a comprehensive approach to a frequent but long-neglected pathology.
Ankle sprain is a traumatic injury of the lateral ligamentous complex (LLC). It represents the most frequent traumatic pathology of the musculoskeletal system and may progress to chronic ankle instability. This condition is characterized by recurrent sprains, episodes of giving way, or a persistent feeling of insecurity in the joint.
Development
Ankle arthroscopy, first described in the 1980s, was for a long time limited to the treatment of chondral lesions and anterior impingement. Its development was markedly slower compared with knee and shoulder arthroscopy. A turning point occurred in the 2010s with the work of Jordi Vega, surgeon, and Pau Golano, anatomist, who contributed to a better understanding of the LLC. They focused on the lateral recess of the joint, whose floor corresponds to the superior part of the ligament. Their studies demonstrated the continuity of the ligamentous fascicles and made it possible to achieve direct access to the ligament. Based on these anatomical findings, new arthroscopic techniques were developed. When the ligament is present but non-functional (scarred, lax, or detached), arthroscopic repair can be performed. In cases of complete rupture, an anatomical reconstruction using the gracilis tendon is feasible. Arthroscopy also offers the advantage of addressing associated intra-articular lesions, such as cartilage injuries and anterior impingement, during the same procedure.
Conclusion
Arthroscopy has profoundly transformed the management of chronic ankle instability. It allows precise diagnostic assessment, arthroscopic anatomical repair or reconstruction of the ligamentous complex, and simultaneous treatment of associated intra-articular lesions. This evolution constitutes a true therapeutic revolution, providing a comprehensive approach to a frequent but long-neglected pathology.