Long-standing lateral ligament instability of the ankle results in
unbalanced loading of the medial joint space and the possible development
of degenerative arthritis. Thirty-six patients who had had lateral ankle
instability for at least ten years and complaints of increasing ankle pain
evidence degenerative changes of the articular cartilage over the medial
half of the talar and tibial surfaces of the ankle joint. These changes
were minimally apparent on roentgenograms unless weight-bearing
roentgenograms were made, but arthroscopy of the joint accurately revealed
the extent of degeneration. After reconstruction of the lateral ankle
ligaments, fourteen of twenty-two patients with mild to moderate arthritic
changes showed both symptomatic improvement and demonstrable widening of
the medial joint space on weight-bearing roentgenograms. Four of five
patients with severe degenerative arthritis subsequently had a total ankle
replacement.