Purpose: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. Materials and Methods: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. Results: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average $8.2{pm}0.9$ (range, 7~10) to $2.7{pm}1.7$ (range, 0~6) and the AOFAS score improved from $46.4{pm}14.6$ points (range, 23~69) to $80.1{pm}9.3$ points (range, 65~95) at final follow-up. Anterior draw test improved $15.2{pm}3.4$ mm (range, 12~23 mm) to $8.8{pm}2.6$ mm (range, 6~13mm), varus stress test improved from $13.9{pm}4.6^{circ}$ (range, $10-18^{circ}$) to $6.2{pm}4.7^{circ}$ (range, $2-18^{circ}$) at final follow up. Conclusion: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.