Recent ruptures of ankle ligaments, diagnosed by arthroscopy, were treated in 95 cases with primary surgical repair followed by plaster immobilization, in 82 cases with plaster immobilization alone for three weeks, and in 104 cases with strapping alone and early mobilization of the joint. The patients were followed up for periods averaging 3.8 years. The following conclusions were drawn. (1) Primary surgical repair of ligament ruptures gave the best results, with residual symptoms of instability in only about 3% of cases. (2) Non-surgical treatment, ie, immobilization in plaster for three weeks or application of strapping and early mobilization gave residual symptoms in almost 20% of the cases. (3) No verifiable difference was found in end results after plaster immobilization and after strapping. (4) Younger patients seemed to have residual instability of the ankle more often than did older patients. (5) The poorest results of non-surgical treatment were found in patients with repeated sprains. (6) In tears of the deltoid ligament or the anterior tibiofibular ligament no residual symptoms were reported in any of the treatment groups. (7) The anterior "drawer sign" could be elicited without anaesthesia in patients with old, unhealed rupture of the anterior talofibular ligament. (8) Although surgical treatment gave the best long-term results, it is not recommended for routine use because (a) postoperative infection and osteoarthritis cannot always be avoided, (b) some patients experience discomfort from the scar, such as altered sensibility and traumatic neuroma, (c) secondary surgical repair of the ruptured ligaments can be performed even several years after the injury, (d) any residual symptoms after non-surgical treatment are usually mild and not disabling, (e) the duration of sick leave after operation is considerably longer than after strapping, (f) routine surgical treatment of these common injuries would greatly increase the work of surgical units. (9) Primary surgical repair should be considered, however, in young patients with a history of ipsilateral sprain(s) and whose activities necessitate perfect ankle function.

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