Chronic lateral ankle instability is quite common after acute lateral ligament injury. The proportion of patients who develop chronic or recurrent instability is controversial, ranging between 5 and 35% of acute cases. Non-surgical treatment is well defined and includes mostly rehabilitation, especially strength training and reflex training. This form of treatment is always recommended as the first line of treatment, even in case of more severe injury of the lateral ligaments (Grade III). This type of treatment has also been shown to be successful in reducing symptoms in more than 50% of all patients with chronic complaints. If non-surgical treatment fails, surgical treatment is recommended. There are many techniques available, all based on either repair or reconstruction, and through the years more than 60 different techniques have been described. Some of these techniques are a more complex reconstruction, so-called non-anatomic reconstruction, using tendon transfers. The ligament reconstructive techniques can be divided into anatomical and non-anatomical reconstructions. The best known is the original Broström technique, with direct repair of the torn ligament ends. In more recent studies, non-anatomic reconstructions have been shown to increase inversion stiffness at the subtalar joint compared with the anatomical procedures, which may lead to abnormally reduced range of subtalar motion. This can lead to an increased risk of degenerative changes or in the medium- to long-term development of osteoarthritis of the ankle. Therefore, these procedures are currently avoided as the fist-line surgical choice. However, in case of reoperation or low tissue quality, tenodesis can still be a viable alternative. Anatomical procedures, in most cases anatomical reconstruction, often called modified Broström procedure techniques, are preferred in the majority of cases. Anatomical reconstructions have been shown to constantly render good and excellent clinical results and are therefore the appropriate first-line surgical choice. During the last years the minimally invasive techniques, including arthroscopic reconstruction have evolved with the results similar to other anatomic reconstructions, using open technique.