A retrospective review of 19 cases of pure tibiotalar dislocation without associated fractures showed that most patients with closed injuries will have a good long-term result. Closed injuries generally have functionally insignificant instability, loss of motion, and no roentgenographic evidence of degenerative changes. The long-term results were worse in open dislocations that had a high incidence of concurrent neurovascular injury. These neurovascular injuries were of minimal functional significance. The role of primary ligament repair is difficult to delineate.