CFL rupture is a negative prognostic factor for return to sport after endoscopic Broström-Gould

Chronic lateral ankle instability (CLAI) often follows repeated sprains and may require surgery when conservative treatment fails. While the anterior talofibular ligament (ATFL) is most commonly injured, the impact of a concomitant calcaneofibular ligament (CFL) rupture on surgical outcomes remains unclear. The purpose of this study is to compare 5-year clinical and functional results of All Inside Endoscopic Broström-Gould (BG) according to the presence or absence of a CFL rupture.

Patients who underwent All Inside Endoscopic BG for ATFL rupture between January 2018 and December 2019 were included and divided into two groups based on preoperative ultrasound: intact CFL (n = 42) or ruptured CFL (n = 88). Outcome measures included failure rate (revision surgery, persistent instability or pain), patient satisfaction (0-10), Simple Foot and Ankle Value (SFAV), Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) score and Ankle Activity Score (AAS). Minimum follow-up was 5 years.

High patient satisfaction was observed in both groups (mean 8.2/10 in the intact and ruptured CFL groups), with comparable functional outcomes. The ruptured CFL group had slightly higher failure (22% vs. 19%) and recurrent instability rates (18% vs. 13%), though not significant. Return-to-work rates were similar (92%), but return to pre-injury sports level was significantly lower with CFL rupture (59% vs. 80%, p = 0.032).

The All Inside Endoscopic BG yields excellent clinical and functional outcomes in the treatment of CLAI, regardless of associated CFL injury. However, complete CFL rupture appears to reduce the likelihood of returning to the same level of sports activity.

Level II, prospective comparative study.