An old injury to the anterior talofibular ligament does not necessarily require surgery. The need for surgery for an old anterior talofibular ligament injury is based on both the impact on ankle motion and the benefit of surgery. An old injury to the anterior talofibular ligament can be examined by ankle MRI or musculoskeletal ultrasound to determine the severity of the injury to the anterior talofibular ligament. If it is a mild injury of the anterior talofibular ligament, which does not have a serious impact on the stability of the ankle joint, surgical intervention is usually no longer performed. Instead, the patient’s pain and swelling are addressed, such as using ultrasound, shockwave, and other physical factors in conjunction with medication. If the injury is severe enough to have caused significant ankle instability, or if there is persistent severe pain or swelling. Ankle arthroscopy or open surgery can be considered to reconstruct the anterior talofibular ligament. After surgery, the ankle can be immobilized with a cast or brace, and after removing the cast or brace, the ankle joint can be gradually functionally exercised. After ankle sprain, it is recommended to consult a doctor in time to clarify whether there is ligament injury and standardize the treatment in time to reduce the probability of sequelae.