From the Research
Surgery for a ruptured anterior tibiofibular ligament is rarely indicated as first-line treatment, and should only be considered in cases of significant ankle instability or complex syndesmotic injuries. Most isolated ruptures of this ligament are managed conservatively with rest, ice, compression, elevation, and physical therapy. The decision for surgical intervention should be based on functional instability, the patient's activity level, and radiographic findings showing abnormal tibiofibular relationships, as suggested by studies such as 1.
When surgery is performed, it usually involves either direct repair of the ligament or syndesmotic fixation using screws or suture-button devices to stabilize the distal tibiofibular joint. The choice of surgical technique may depend on the specific characteristics of the injury and the patient's needs. For example, a study published in 2022 1 compared the outcomes of anterior tibiofibular ligament's distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients, and found that the distal fascicle transfer group had significantly higher American Orthopedic Foot & Ankle Society (AOFAS) scores.
Some key points to consider when evaluating the need for surgery include:
- The presence of significant ankle instability or functional impairment
- The patient's activity level and requirements for return to sport or daily activities
- Radiographic findings showing abnormal tibiofibular relationships or widening of the ankle mortise
- The presence of associated fractures or other injuries that may require surgical stabilization
It's also important to note that most patients with isolated anterior tibiofibular ligament ruptures achieve good outcomes with conservative treatment, as this ligament has reasonable healing capacity when the ankle is appropriately protected during the healing phase, as discussed in studies such as 2 and 3. Therefore, surgery should be reserved for cases where conservative management has failed or is unlikely to be successful.