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

Abstract

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. For persistent lateral ankle instability, the purpose of this systematic review and meta-analysis (SRMA) was to compare the clinical results of arthroscopic and open repair. 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. 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. Current evidence indicates that open Brostrom-Gould repair yields better functional outcomes and reduces knot-related discomfort. Conversely, arthroscopic repair offers the benefits of reduced wound-related complications and superior postoperative pain control. With comparable rates of complications and operative time, arthroscopic techniques remain a viable and less invasive alternative, particularly in experienced hands. The online version contains supplementary material available at 10.1007/s43465-025-01473-8.