Over a 10-year period, 19 patients were seen who had the clinical features of disruption of the syndesmotic ligaments of the ankle. Seventeen of these were available for follow-up by history and 13 by physical examination. The patients underwent an arthroscopy for persistent symptoms an average of 2 years following the injury. Preoperatively the patients had a positive external rotation stress test. A triad of pathological features was found: disruption of the posterior inferior tibiofibular ligament; rupture of the interosseous ligament; and chondral fracture of the posterolateral portion of the tibial plafond. Arthroscopic resection of the torn portion of the interosseous ligament and the chondral pathology successfully relieved the symptoms in most of the patients. There was a statistically significant improvement in pain, swelling, stiffness, stability, limp, and activity levels. The external rotation stress test was converted to negative. Patients with persistent pain following a syndesmotic disruption of the ankle can benefit substantially by removal of the intraarticular pathology associated with such injuries. Residual instability of the syndesmosis itself did not seem to be a problem.