Acute ankle ligament injuries are common and, if untreated, may result in chronic ankle instability (CAI). Lateral ankle injuries are more prevalent compared to medial ankle injuries, indeed deltoid injuries are rare and associated with ankle fractures or dislocation. Conservative management, including functional rehabilitation, is the method of choice in acute cases, while surgical management can be reserved for high-demand athletes or in case of failure of early management. For lateral ankle instability several surgical options are available. Anatomic repair of the anterior talofibular and calcaneofibular ligaments is recommended, if possible, or anatomic reconstruction with autograft or allograft. The deltoid, talocalcaneal, and calcaneonavicular ligaments, referred as the medial ankle ligamentous complex, provide stability to the medial ankle. Injuries to the deltoid ligament can lead to medial-sided ankle pain and subsequent instability. Imaging modalities such as stress radiographs and magnetic resonance imaging can be used to confirm the diagnosis. Both conservative and surgical management criteria are similar to those for the lateral ligament complex, with rehabilitation based on proprioception and muscle stretching training, and, in case of failure, ligaments repair or reconstruction. Ankle arthroscopy is an important adjunct to ligamentous repair and should be performed to identify intra-articular conditions associated with CAI. Tenodesis procedures are not recommended for their poor long-term results and the consequent alteration of the ankle and hindfoot biomechanics.