Ankle ligament surgery in Mumbai

What this operation is

If your ankle gives way — on a kerb, on a crowded platform, coming down stairs — and it has been doing it for months or years after a sprain that never properly healed, this is the operation that addresses it. Whether it is the right operation for you is most of what this page is about, and for a good number of people the answer is no.

The ligaments on the outside of your ankle are meant to hold the joint together when your foot rolls. After a bad sprain they can heal long, or not heal at the right tension. The joint then sits slightly loose, and rolls more easily than it should.

I repair those ligaments through two small keyhole incisions. In 2025 I did 132 of these, and I have done between 100 and 120 a year on average. All of them arthroscopically — keyhole, not open.

I should say one thing at the outset, because you will find it everywhere else. You will read that this operation has a ninety or ninety-five per cent success rate. I am not going to tell you that, because I cannot show you where the number comes from. There is a section further down that sets out what the published evidence actually says, including the uncomfortable parts. I would rather you read it here than find it somewhere else afterwards.

Repair or reconstruction — they are not the same operation

Most people arrive searching for “ankle ligament surgery” without knowing which of the two they need. Explaining the difference is part of my job at the consultation, so let me do it here.

The proportion matters, and it is not what the internet will tell you:

Of roughly 130 ligament operations I do in a year, three to five are reconstructions.

In my practice, reconstruction is mostly what I do when a repair has already been tried and failed. It is not the routine operation here. There are other reasons a surgeon may choose it from the outset — if there is too little usable ligament left to repair, or where the joints are generally very loose — and in a published survey of specialist foot and ankle surgeons, graft reconstruction was linked to generalised laxity or poor ligament quality.^[1]

So if reconstruction is recommended to you as a first operation, that is not automatically over-treatment. It means something specific about your ligament or your joints. Ask what.

If you have read a page describing donor tendon from a tissue bank as the normal way this is done, that reflects a different healthcare system’s practice rather than mine.

Why your ankle keeps giving way

Not every unstable ankle is a loose ligament, and this is the single most important thing on this page.

Recurrent giving way is a broader problem than a torn ligament. It can come from the ligament, yes — but also from the peroneal tendons on the outside of the ankle, from the joint below the ankle, from the alignment of your heel, or from the nerve-and-muscle control that keeps you upright without you thinking about it.^[3]

That distinction decides whether an operation will help you. Which is why the next two sections are the ones I would read first.

When I stop waiting and operate

You will find guidance saying you should try three to six months of physiotherapy before surgery is considered. That figure does not come from a trial. It comes from a questionnaire sent to specialist foot and ankle surgeons — thirty of the thirty-two invited replied — seeking consensus on how these patients should be approached.^[1] And it applies specifically to patients whose ankle feels unstable but tests normally. For ankles that are genuinely loose on examination, and for high-level athletes, the same survey records a trend towards operating earlier — after non-surgical treatment has been tried and has failed.^[1]

I want to be precise about what that document is, because it is often described as though it settled the question. It is an expert consensus survey, not a randomised comparison. It tells you what experienced surgeons do. It does not tell you what works best.

One qualification matters and I want to state it before I go further: that consensus places surgery after non-surgical treatment has been tried and has failed, in every case. Being an athlete, or having sprained the ankle many times, or having lived with it for years, does not on its own replace a proper course of rehabilitation. What follows is about when I stop waiting — not about skipping the attempt.

I would go further than that.

By the time most patients reach me in Mumbai, they have not been sprained once. They have been sprained four or five times over several years, and something else has usually happened in the meantime.

So instead of a number, I weigh three things.

1. What you need from the ankle. A professional athlete and a desk worker with the same scan are not the same problem. If you are an athlete, another injury is a risk I cannot take lightly, and I will offer surgery sooner. If your work and your life are not being limited, we have room to wait and see.

2. What the structures actually look like. How good or bad is the ligament itself? And when the ligament went, did the peroneal tendons — the muscles that compensate for a loose ankle — survive intact, or are they injured too? If the compensating structures are damaged as well, rehabilitation has much less to work with.

3. Whether the cartilage is being damaged. This is the one people underestimate, and it is the main reason I move sooner in some patients.

I should be honest that this is my clinical reasoning rather than a proven benefit. We know cartilage lesions are common in unstable ankles, and we know a cartilage lesion makes a ligament repair more likely to fail.^[4] What has not been shown by any study I can point you to is that operating earlier prevents cartilage damage from developing. It is a mechanical argument, and I find it persuasive. It is not a demonstrated result.

Put concretely: a young patient with a first episode, no tendon injury and no cartilage damage can go to rehabilitation with a good chance. Someone on their fourth or fifth episode, with a split tear in the peroneal tendon and a cartilage injury alongside the ligament tear, is unlikely to become stable and pain-free with rehabilitation — because the structures that would compensate are damaged too. That patient should be offered surgery early.

Physiotherapy, when it is the right answer, is not rest. The clinical practice guideline recommends proprioceptive and neuromuscular therapeutic exercise, and it is explicit that bracing or taping should not be used as a stand-alone treatment for an unstable ankle.^[2] Strengthening work sits inside the rehabilitation programme too — but the headline recommendation is the balance and control work, and that is the part people skip.

Who this operation will not help

An honest page has to answer this, and almost none of them do. Ligament surgery will not correct a problem that is not the ligament.

Telling those apart is a clinical job, not a scan-reading job.

Here is what I am listening and looking for.

• If your ankle does not feel loose when I examine it, but it hurts — or if it catches and locks, as though something is getting stuck inside the joint, and that is what makes you trip — that is more likely to be a cartilage problem than a ligament one. An operation to tighten the ligament will not fix it.
• If the peroneal tendons are inhibited — not firing properly when they should — that has two possible causes and they need different treatment. The tendons themselves may be injured. Or the problem may be neuromuscular, coming from higher up: the spine, or a nerve problem elsewhere. Repairing the ligament corrects neither.
• If the giving way is coming from the joint below the ankle, rather than the ankle joint itself, an ATFL repair is the wrong operation.
• If your heel turns inwards — a varus heel — the alignment keeps loading the outside of the ankle. A perfectly performed ligament repair can still fail if the shape of the foot is left uncorrected.

None of this is quick to work out, and it is not something a scan hands you.

If I examine you and conclude that surgery will not solve your main problem, I will tell you so at the consultation. That is a more useful visit than an operation that was never going to work.

What raises the risk of it failing

Because there is no honest universal success rate, this section is the one that actually answers “what will happen to me.” These are the things that change your odds — and most of them are measurable on your own scans.

A study of 199 ankles followed for an average of five years after a modified Broström repair^[4] found five factors significantly associated with the repair failing:

1. Generalised ligamentous laxity — being built loose. This was the only one that held up as an independent predictor when the factors were analysed together
2. A cartilage lesion on the talus — the bone inside the ankle joint
3. Widening at the syndesmosis — the joint between the two shin bones just above the ankle
4. Talar tilt greater than 15° on stress X-rays
5. Forward movement of the talus greater than 10 mm on stress X-rays

A separate review of nine studies covering 762 patients found a consistent overlapping set: generalised laxity, high-level sport, female sex, a varus heel, poor ligament quality, and syndesmotic widening found during the operation.^[5]

Two things I want to be careful about.

These are risk modifiers, not disqualifications. The authors of the nine-study review are explicit that treating them as established contraindications is not supported.^[5] Having one does not mean the operation will not work for you. It means we should talk about it before, not after.

And a caution on how to read the list: four of the five were associated with failure when looked at one at a time. Only generalised laxity survived as an independent predictor once they were analysed together. So this is a set of things worth knowing about your own ankle — not a scoring system, and not a prediction.

The last two are things you can see on your own films. If you want to know where you sit, ask me to show you your stress X-rays at the consultation. That is a more useful conversation than any percentage I could quote you.

If your body weight is higher

A study of 69 patients compared arthroscopic repair in people with a BMI of 30 or above against those below it, followed for at least two years.^[6]

I have given you that whole finding rather than the headline, because “BMI is not a contraindication” on its own would be a reassurance the study does not support. And a threefold difference in complications that fails to reach significance in 69 patients is not the same as no difference — the study is simply too small to tell.

Two limits on that study before you apply it to yourself: everyone in it had isolated lateral instability treated with one specific technique, and it was not large enough to settle the complication question either way.

What it means in practice: I will still offer you the operation. I will also tell you what the authors concluded — that temporary numbness over the top of the foot appears more likely in this group — and that I would expect recovery to take a little longer.

How I do this operation

Keyhole, not open

I do all of these arthroscopically — including the reconstructions.

Note what that does and does not say. No difference was detected — which is not the same as the two being proven equivalent; no study was designed to show that. And the earlier milestone is putting weight on the foot, not getting back to your sport sooner. On that endpoint the two approaches came out the same.

I prefer the keyhole approach and I do all of these that way. I am not going to tell you the published evidence proves it superior, because it does not.

The anchor, and why I do not use extra tape

You may have read about ligament repairs being reinforced with a strip of tape — often marketed as an “internal brace”. It is being promoted heavily in this city.

My technique is different, and the difference is worth understanding.

So the repair is reinforced — but with the tape that is already part of the anchor holding the ligament down. There is no second implant and no second consumable on your bill.

That matters, because the evidence on separate tape augmentation is thinner than the marketing suggests. A systematic review pooling three randomised trials, 235 patients in total, found no significant difference in overall outcome measures between the modified Broström repair and suture-tape augmentation.^[9] One of those trials also found the tape group’s treatment cost about 1.3 times more.^[8]

None of that makes tape a bad idea. It means the case for adding a separate implant, at extra cost, is not as strong as you will be told.

If your joints are all loose

Some people are simply built loose — the ones who can bend a thumb back to the forearm. About one in five patients I operate on for this problem has generalised laxity.^[4]

The published evidence is pessimistic about this group, and that is the number you should plan around. The five-year study above found clinical failure in 45.2% of patients with generalised laxity, against 10.8% without.^[4] It is the best evidence anyone has on this question and I am not going to talk you past it.

Here is what I tell those patients.

And there is a reason I do not simply tighten these ankles harder.

A loose-jointed person’s normal is not the textbook’s normal, and the goal is to give you back your ankle, not somebody else’s.

I should be straight with you about where that leaves things. My own experience of operating on hyper-lax patients has been better than the published figure would predict — but I am not going to put my own numbers next to a peer-reviewed five-year study as though the two carried equal weight. They do not, and they will not until my work has been through the same scrutiny.

So plan around the published figure, and treat my experience as a reason for me to be careful with your ankle rather than a reason for you to expect a different result.

What else I fix at the same time

Pooled across twelve studies of people with chronic lateral ankle instability — the specific problem this page is about, not every unstable ankle — about one in three had a cartilage lesion. The pooled figure was 32.2%, with a range of roughly 23% to 42% across the studies.^[10] And a cartilage lesion was among the factors associated with a ligament repair failing.^[4]

That is the reason what is inside the joint matters — not simply that we might find something, but because it can change whether the repair holds.

Loose fragments and scar tissue get dealt with in the same sitting. They add a few minutes and they do not change your recovery or your outcome.

Cartilage is different, and it does change your recovery. If I treat a cartilage lesion alongside the ligament, the timetable moves — and I set out exactly how in the recovery section below. I would rather you know that before the operation than wonder afterwards why you are behind the schedule you read on a website. How cartilage lesions themselves are assessed and treated is covered on my ankle arthroscopy page.

Recovery, in Mumbai terms

Everything here is the guidance I give in clinic. It is not a promise, and what applies to you depends on what was done inside the joint.

Two things before the table. These are permissions, not achievements — the point at which I expect the ankle to tolerate the activity, not the point at which it will feel normal. And every one of them is conditional on how the ankle is actually doing: swelling settled, movement back, strength returning, no pain that stops you. If those are not there, the date moves.

After a graft reconstruction, the timeline is the same. People expect it to be much longer and it is not.

If cartilage was treated at the same time, two things change and they are worth separating.

1. Early weight-bearing is delayed — you will be off the ankle longer than after a ligament repair on its own.

2. The longer arc catches up. You will be behind the table above in the early weeks, and then gradually close the gap, reaching full recovery at around three to four months.

So the beginning is slower. The destination is not further away.

One caveat on the whole table. The ESSKA-AFAS consensus on rehabilitation after ankle ligament surgery describes the late rehabilitation and return-to-sport phase as goal-orientated.^[11] I agree with that, and in my own practice I judge progress on what you can actually do rather than on what week it is. Treat the dates above as the shape of a normal recovery, not a schedule you have to hit.

Keeping the wound dry

The dressing needs to stay dry. Cover the operated area before showering — a plastic wrap or a proper cast cover both work, and the easiest method is cling film: the kitchen wrap you already have, wound around the operated area.

If it gets wet or dirty, come in and we will change the dressing rather than leaving it.

Getting through the Mumbai rains

Be careful in the Mumbai rains. Avoid slippery surfaces — this matters most while you are on crutches or a walker, because that is when a slip does the most damage.

Wear the cast cover when walking in the rain, so the boot and the dressing under it do not get wet.

And if it gets dirty, report to us immediately for a dressing change.

When to call us

What the longer-term evidence shows

I would rather show you this than a success rate.

That is a study of children and adolescents, and I cannot tell you it applies to a 35-year-old — young tissue heals differently and the demands are different. I include it for one thing only, which does travel: the gap between “back to normal life” and “back to the same level of sport” is real, it is wide, and most pages do not mention it exists.

For adults, the five-year study discussed earlier in this page is the better guide to how these repairs hold up over time.

The risks, honestly

Every operation carries risk, and the characteristic risk here is not dramatic — it is numbness.

The nerve that gives sensation to the top of the foot runs close to where I work. The commonest complication after this operation, by a distance, is a patch of numbness there that lasts a few weeks.

I audit my own complications, and I would rather give you mine than a published average from another surgeon’s practice.

Here is where that stands. The audit covers approximately 800 to 1,000 patients operated between 2014 and 2026 — a twelve-year window. The shortest follow-up is nine months, the longest is eight years, and between 10 and 12% of those patients were lost to follow-up along the way. Complications treated at another hospital are not counted in my figures.

What I have not yet separated out is the breakdown by operation — how many of those patients had a ligament repair specifically, and what the rate was for that group on its own. That is part of what is still being compiled, and it is one of the reasons there is no percentage on this page yet.

Two definitions, because they decide what a number means. I count as a complication any undesired effect that stops a patient getting the result they came for. And I count an ankle as having recurrent instability if there is looseness in the ankle, or apprehension about pivoting activities, or persistent pain.

I have deliberately not put a percentage here yet. The rule I have set for this page is that a rate has to be published with its event counts to mean anything, and those are still being compiled properly. When they are, the number will appear here with everything above attached to it.

I would rather show you the working than the number. A complication rate quoted without its denominator and its follow-up is reassurance rather than information, and you should be sceptical of one wherever you find it — including here.

The complication nobody mentions

There is one more, and it is worth knowing about because it is easy to fix.

If it keeps bothering you, the knot can usually be removed once the repair has healed — around three months — as an outpatient procedure under local anaesthetic.

I mention it because patients who have not been told about it assume the worst. Usually it is just a knot under thin skin. But it is worth showing me rather than deciding for yourself what it is.

If it goes again

Sometimes an ankle gives way again a year or two after surgery. When it does, the first question is not what to re-operate on — it is why it happened.

Was it a fresh injury? If something external caused it — a genuine re-injury — then the repair failed for an understandable reason, and it can be repaired or reconstructed again.

Or did it fail from the inside? That is the more important possibility. Sometimes tissue simply does not hold, or stretches out again over time, and no one did anything wrong. But there are things that can be found and corrected, and they are worth looking for before operating again:

• A varus heel — the heel turning inwards, loading the outside of the ankle with every step
• A missed cartilage injury in the joint
• Neuromuscular imbalance — the control problem rather than the ligament

Those factors have to be found and treated alongside the revision. Repeating the same repair without correcting the cause is how a second operation becomes a third.

For a revision I use a tendon graft — one of the spare tendons from the leg, or from the forearm — fixed with anchors and buttons. There is no high-quality evidence establishing that a graft from your own body is better than a donor graft; a review of 12 studies covering 357 reconstructions could not determine which is safer or more effective.^[7] My own preference is for your own tissue, and I will explain my reasoning if you ask, but I am not going to present a preference as a proven fact.

On donor tendon in India

Donor tendon is available. There is a registered tissue bank in Mumbai, and if I need a graft I can pre-order it and have it ready for the operation.

I still prefer to use your own tissue. Do not assume donor tissue will be available to you — it is worth confirming for your specific hospital and its tissue bank before you plan around it, rather than taking it from any website, including this one.

A note on newer synthetic options

In selected cases I use a polyester scaffold as reinforcement, placed arthroscopically. I reserve it for two situations: people who are severely hyper-lax, and revision cases where a previous repair has failed.

I want to be careful about how I describe where this stands, because it is genuinely new. In my words, it is just coming into vogue. There are no long-term published results for it — not good ones and not bad ones. That is not the same as it being proven safe, and it is not the same as it being proven to work. It means the studies that would tell you either way have not been done yet.

So if I think a scaffold is the right choice for your ankle, I will say so and I will explain why. What I will not do is present it to you as an established alternative, because it is not one yet.

What the evidence shows — and what it doesn’t

I said at the top that I would not quote you a success rate. This is why.

Sit with the second half of that for a moment. Ten of fourteen published reviews concluded one operation was better than another, on evidence that could not support the conclusion.

And the reason those conclusions could not be supported is worth stating exactly:

Improvement after an operation is not proof that the operation caused it. Without a comparison group you cannot separate the effect of surgery from natural healing, from the rehabilitation that came with it, or from the fact that patients chosen for surgery were chosen for a reason.^[13]

Which points straight at what has been missing — and, for this operation, at what finally exists.

The one randomised comparison

That paragraph names exactly what is usually missing: a comparison group. So I want to show you the one study that has it, because it is the closest anyone has come to the question you are actually asking — what happens if I do the exercises instead?

Read it carefully, because it cuts both ways. The exercises worked. They worked faster than surgery for getting back to sport, and for walking, stairs and standing there was nothing to choose between them at a year. Surgery went further by twelve months and held there.

What it does not show is that surgery is better than rehabilitation. It enrolled a narrow group — adults between 18 and 40, all with one specific pattern of tear, with cartilage damage, previous surgery and other injuries deliberately excluded. That is not the range of people who come to see me. The repair was also done with two anchors, which is not quite how I do it; I use the tape built into the anchor rather than adding separate tape. And one trial of 56 people, 49 followed to a year, is a beginning rather than a settled answer.

What it does do is remove my excuse for vagueness. The comparison has been attempted, once, and the honest summary is that both paths work and they work on different timetables.

So when I recommend surgery, I am recommending it on mechanics — there is a structure that is loose, I can demonstrate it on examination and on your stress films, and repairing it restores stability — and on what I see in my own patients across that twelve-year audit window. There is now one randomised comparison rather than none, and it is worth having. But a single trial in a narrow group does not carry a recommendation for you, and the wider literature behind it is still thinner than the confident tone of most writing about it suggests.

One boundary on all of this. What I have set out here is what the evidence says about this operation for this problem. The wider question — how good the evidence is for ankle keyhole surgery generally, across all the different problems it gets used for, and what an umbrella review can and cannot tell you about any of them — I deal with on my ankle arthroscopy page.

Cost and insurance

I am not going to publish a price range. The ranges you will find on aggregator sites are marketing rather than estimates. What I can tell you is what moves the cost.

1. The implants. A ligament repair needs anchors. That is the main thing separating this from a procedure that needs no implant at all.

2. No extra tape. As above — my technique reinforces the repair using the tape built into the anchor, so there is no second consumable. Where a surgeon does use a separate tape augment, the cost rises by that consumable.

3. Cartilage work in the same sitting changes what is done and therefore what it costs.

4. A reconstruction rather than a repair involves a graft and additional fixation.

If you are using cashless insurance

Most policies do cover the anchors and consumables — they are essential to the operation, not optional extras, and insurers generally treat them that way. Where problems arise it is almost always something specific excluded in the fine print of a particular policy. Check yours rather than assuming.

Before admission, confirm two things: that the hospital accepts your insurer, and that your pre-approval has actually been approved, not merely applied for.

Where I operate

I consult at Prabhadevi and Kemps Corner, and I operate at seven hospitals across South Mumbai and the western suburbs:

• Advanced Orthopedics — my own centre
• Breach Candy Hospital
• HN Reliance Hospital, Girgaon
• Saifee Hospital, Charni Road
• PD Hinduja Hospital, Mahim
• PD Hinduja Hospital, Khar
• Lilavati Hospital, Bandra

Which one we use depends on what is most convenient for you and where your insurance works best.

Life after the operation

One thing this operation cannot do, and it is the commonest misunderstanding I meet: surgery restores the structure. It does not build the muscle.

An ankle that has been giving way for years has usually lost the strength and the balance control that would normally protect it. The repair gives you back the ligament. The rehabilitation gives you back the control. Skip the second and the operation underdelivers, and no technique or implant changes that.

Common questions