**3.2 Operative treatment**

Operative treatment is indicated when conservative treatment failed to resolve the patients'symptoms. Patients with higher physical demands are less likely to become asymptomatic with conservative measures. Patients with mechanical instability, repeated ankle sprains, osseous fragments in the malleolar region, and limitations in on-demand activities may benefit most from operative treatment. It has been reported that patients who received surgical repair showed better muscle endurance and postural stability than patients who had conservative treatment [53].

The goals of surgery are to reestablish ankle joint stability with reduced risk of future sprains in the short term and of articular degeneration in the long term.

Several surgical techniques to reestablish ankle joint stability have been reported either by open or arthroscopic approach. These techniques can be roughly divided into two categories: suture repair and graft reconstruction.
