Meta-analysis of surgical approaches to lateral ankle instability: Open Broström versus arthroscopic Broström versus...

Anterior talofibular ligament (ATFL) injury is a common cause of chronic lateral ankle instability and is more frequent among those who are active and play sports. There are multiple techniques to repair the ATFL, including the historically gold-standard Open Bröstrom (OB) technique, the Arthroscopic Bröstrom (AB) technique, and the more novel arthroscopic Lasso-Loop (LL) technique. This meta-analysis seeks to compare outcome statistics of these techniques for ATFL repair.

A literature search was conducted on PubMed and Embase for comparison studies or randomized controlled trials that included at least two of the surgical techniques and at least one relevant functional outcome or complication statistic up until October 2025. Statistical analyses were performed using Review Manager Web, and a P-value ≤0.05 was considered statistically significant.

1426 patients across 21 studies were included in this analysis. When compared to OB, AB had a significantly lower post-operative Visual Analog Scale (VAS) score (P = 0.01), higher Karlsson score (P < 0.001), higher American Orthopaedic Foot and Ankle Society (AOFAS) score (P = 0.003), and shorter time to return to daily work (P = 0.02). Compared to OB, LL had a significantly lower VAS score (P < 0.001) and higher AOFAS score (P = 0.02). However, OB had a lower rate of range of motion (ROM) restriction (P = 0.002) and shorter time to return to running (P = 0.01) when compared to LL. No significant results were found comparing AB and LL.

This study found that AB had a significantly lower VAS score, significantly higher Karlsson and AOFAS scores, and significantly shorter time to return to daily work compared to OB. LL also had significantly lower VAS and significantly higher AOFAS scores compared to OB. However, OB had a significantly lower risk of ROM restriction and significantly shorter time to return to running than LL. The minimally invasive AB and LL techniques seem to be the superior treatment methods for ATFL injuries when compared to OB repair, with no clinically significant differences seen between the two.

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