Current concepts in arthroscopic treatment for chronic lateral ankle instability: a clinical practice review

Chronic lateral ankle instability (CLAI) is a frequent sequela of acute lateral ligament injury, causing recurrent sprains, persistent pain, and functional limitations, particularly among athletes and active individuals. While most acute ankle sprains respond well to conservative treatment, approximately 20-30% of patients experience persistent mechanical or functional instability requiring surgical intervention. In recent years, arthroscopic techniques have grown in popularity due to their minimally invasive nature, ability to address concomitant intra-articular pathology, and favorable recovery profiles compared to open surgery. This clinical practice review integrates recent evidence from randomized controlled trials, comparative cohort studies, and technical reports with expert clinical experience to provide practical guidance on the arthroscopic management of CLAI. For patients with adequate ligament tissue quality, arthroscopic Broström repair remains the preferred first-line option, offering high return to sport (RTS) rates and low complication rates. For cases involving revision, poor-quality tissue, or generalized ligamentous laxity, arthroscopic ligament reconstruction using autografts or allografts is recommended. Concomitant procedures such as synovectomy, loose body removal, and cartilage debridement or microfracture can be performed during the same operation. A structured postoperative rehabilitation program is essential for achieving optimal outcomes. Early protected mobilization is followed by progressive range of motion (ROM) and strengthening phases, with sport-specific training typically initiated at about 3 months postoperatively. Current evidence suggests that arthroscopic management yields comparable clinical results to open procedures, while enabling the simultaneous treatment of associated joint pathologies and potentially facilitating faster recovery. Arthroscopic management of CLAI should be regarded not merely as a surgical alternative, but as a comprehensive clinical approach that integrates diagnosis, surgical decision-making, and rehabilitation for optimized patient outcomes. This review aims to provide an evidence-informed framework to guide orthopedic surgeons and sports medicine clinicians in the individualized, evidence-based management of CLAI.