Chronic ankle instability treated with a periosteal flap augmentation: A case report

Chronic lateral ankle instability is a common complication of ankle sprains and may lead to persistent pain, recurrent giving-way episodes, and functional impairment, with a progressive risk of cartilage damage and ankle osteoarthritis [2,3]. Although anatomical repair of the lateral ligament complex remains the gold standard surgical treatment, particularly through the modified Broström procedure, its limitations become apparent in longstanding or recurrent cases [4,5].
We report the case of a patient presenting with chronic lateral ankle instability that had evolved over several years, with symptomatic recurrence after a previous surgical procedure. Clinical examination revealed lateral laxity associated with mild hindfoot varus. Imaging studies, including standard and stress radiographs as well as magnetic resonance imaging (MRI), demonstrated a rupture of the anterior talofibular ligament (ATFL).
Ligament reinsertion reinforced with a pedicled periosteal flap was performed. Postoperative recovery was uneventful, with six weeks of immobilization followed by early functional rehabilitation.
At one-year follow-up, the clinical outcome was favorable, with resolution of pain, absence of instability episodes, and satisfactory ankle function on clinical examination, without postoperative complications.
Ligament augmentation using a pedicled periosteal flap represents a reliable anatomical surgical option for the management of chronic lateral ankle instability, particularly in longstanding or recurrent cases in which simple repair techniques may be insufficient [1,7,8].