Both Open and Arthroscopic ATFL repair have similar overall complication rates: study

The most effective treatment for chronic lateral ankle instability is still open lateral ankle ligament repair. However, because arthroscopic repair is less intrusive and more surgeons are choosing it, it has become more and more common.

Rajesh Kumar Rajnish et al conducted a systematic review and meta-analysis (SRMA) to compare the clinical results of arthroscopic and open repair for persistent lateral ankle instability.This SRMA was conducted per PRISMA guidelines. A comprehensive literature search was performed across PubMed, Embase, Scopus, and the Cochrane Library using predefined keywords. Both prospective and retrospective studies comparing arthroscopic and open lateral ligament repair were included.

The key findings of the study were:

• Open repair demonstrated significantly superior functional outcomes as reflected by higher AOFAS scores (MD 0.68, 95% CI 0.10–1.25; p = 0.02), Karlsson scores (MD 1.08, 95% CI 0.38–1.78; p = 0.003), and JSSF scores, along with a significantly lower incidence of knot-related pain (OR 3.81, 95% CI 1.25–11.60; p = 0.02).

• Although Tegner activity scores showed no significant difference (MD − 0.05, 95% CI − 0.73 to 0.62; p = 0.88), arthroscopic repair was associated with lower postoperative pain levels (VAS score: MD − 0.47, 95% CI − 0.77 to − 0.17; p = 0.002) and fewer wound-related complications (OR 0.42, 95% CI 0.20–0.91; p = 0.03).

• No significant differences were observed in overall complication rates (OR 0.84, 95% CI 0.58–1.20; p = 0.33), infection, nerve injury, radiological outcomes (anterior talar displacement and talar tilt), or operative duration.

The authors concluded that – “Current evidence suggests that open Brostrom–Gould procedures offer better clinical outcomes and less knot-related pain. However, arthroscopic procedures have fewer wound related complications and superior pain control. Despite limited high-quality studies, both approaches show similar overall complication rates, nerve injuries, radiological outcomes, and surgery durations. The evidence must be strengthened by high-quality RCTs with larger sample sizes and longer follow-up periods.”

Further reading:

Outcomes of Open Versus Arthroscopic Anterior Talofibular Ligament Repair: An Updated Systematic Review and Meta-analysis

Rajesh Kumar Rajnish et al

Indian Journal of Orthopaedics (2026) 60:57–73

https://doi.org/10.1007/s43465-025-01473-8