Open versus arthroscopic repair for chronic lateral ankle instability: a critical review and description of arthroscopic techniques
Background: Ankle inversion injuries occur at a rate of 2.15 per 1000 person-years, frequently involving the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). While conservative management is effective for 80% of patients, the remaining 20% develop chronic lateral ankle instability (CLAI). The open Broström-Gould procedure remains the established surgical standard, yet arthroscopic techniques are increasingly utilized to minimize soft tissue morbidity and accelerate recovery.
Objective: This review evaluates the comparative efficacy, anatomical considerations, and technical methodologies of open versus arthroscopic lateral ligament repair for the management of CLAI.
Key Points: Anatomical studies indicate that the ATFL and CFL share a common fibular insertion, suggesting that ATFL tensioning may sufficiently stabilize the CFL without direct repair. The open Broström-Gould technique reinforces the repair using the inferior extensor retinaculum (IER), though the necessity of this modification is debated due to anatomical variations in IER morphology. Arthroscopic approaches, including all-inside and outside-in techniques, demonstrate biomechanical equivalence to open repair in cadaveric models. Clinical data suggest arthroscopic repair yields comparable functional outcomes, such as American Orthopaedic Foot and Ankle Society (AOFAS) scores, with potential advantages in surgical duration and time to weightbearing. However, some meta-analyses report higher complication rates, specifically superficial peroneal nerve paresthesia, associated with arthroscopic interventions.
Conclusion: Both open and arthroscopic Broström-Gould procedures are effective for treating CLAI. While arthroscopic repair offers a minimally invasive alternative with faster early recovery, further long-term randomized controlled trials are required to establish definitive superiority regarding complications and durable stability.
