Surgical Management of a Grade II Anterior Talofibular Ligament Tear in a Patient With Ehlers-Danlos Syndrome: A Case Report

BACKGROUND: Ankle sprains are common injuries typically managed conservatively. However, individuals with hypermobile Ehlers-Danlos syndrome (hEDS), a connective tissue disorder associated with joint instability, may demonstrate poor healing and persistent instability. This case highlights surgical management of a Grade II anterior talofibular ligament (ATFL) tear in a patient with hEDS and the challenges of ankle instability. CASE PRESENTATION: A 21-year-old female with hEDS sustained an inversion injury to her right ankle resulting in a Grade II ATFL sprain and chronic instability. Three months of conservative management including use of lace-up ankle stabilizing orthosis and physical therapy failed to resolve symptoms. Surgical intervention with ankle arthroscopy and modified Brostrom-Gould ligament repair was performed. OUTCOME AND FOLLOW-UP: At 3 months follow-up, the patient had restored range of motion and no reported pain and resumed dynamic activities such as running and jumping. DISCUSSION: This case highlights the importance of recognizing how underlying connective tissue disorders such as hEDS can alter expected recovery trajectories and contribute to persistent instability. When mechanical instability persists despite an adequate course of conservative care, surgical stabilization may be necessary more frequently in this population to achieve successful outcomes. JOSPT Cases 2026;6(1):50-55. Epub 26 December 2025. doi:10.2519/josptcases.2025.0203