Radiographic lateral stress views can be performed applying set forces of inversion (90). But results of such instability testing can be questionable if thecalcaneofibular ligament is intact and these patients still have instability (97,98)Arthroscopically, there is ballooning of the anterolateral capsule whichappears and feels thinner than normal. One frequently sees scarring of thelateral gutter and syndesmosis with associated loose bodies or ossicles andlateral dome or plafond chondral changes.Treatment is either an open or closed modified Brostrom repair with threeweeks in a below-knee cast then standard physiotherapy. Arthroscopic resultsare as good as open (99).Krips R (100) in 2006 produced an excellent article regarding ankle instabilityinjuries and reconstruction. Takao M (101) in 2005 clearly demonstrated intheir series of 72 patients that arthroscopy can be used to diagnose the causeof residual pain after and ankle sprain in most cases that are otherwiseundiagnosable by clinical examination and imaging. Also Okuda R (102) in2005 interestingly showed in their series of 30 consecutive patients that lateralligament reconstruction can be successful regardless of focal chondral lesionsas long as pre-op weight-bearing x-rays do not show any joint spacenarrowing.
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