All-arthroscopic repair of talar-sided anterior talofibular ligament insertion tears using knotless anchors: A retrospective case series

Objective To describe the surgical technique and evaluate the clinical efficacy of all-arthroscopic knotless anchor repair for talar-sided anterior talofibular ligament tears in the treatment of chronic lateral ankle instability. Methods This retrospective case series included 11 patients treated between February 2020 and October 2022. All patients presented with persistent lateral ankle pain and instability following an ankle sprain that did not respond to at least 6 months of conventional conservative management. Preoperative assessment included physical examination (positive anterior drawer and varus stress tests) and magnetic resonance imaging, which verified talar-sided anterior talofibular ligament insertion tears. The procedure was performed under complete arthroscopic visualization. Initially, the ankle joint was debrided to remove hyperplastic synovium and loose bodies. Then, the anterior talofibular ligament was tensioned using a suture tape passed through a two-wire loop sleeve. Finally, the ligament was secured with an absorbable knotless anchor implanted at the anatomical talar insertion site of the anterior talofibular ligament. Results All 11 patients were followed up for a mean duration of 13.27 ± 2.41 months. At the final follow-up, significant clinical improvements were observed compared with the preoperative status: the American Orthopaedic Foot and Ankle Society Ankle–Hindfoot score increased from 42.62 ± 2.2 to 95.73 ± 1.43 (p < 0.001), and the pain score on a visual analog scale decreased from 6.47 ± 1.25 to 1.73 ± 1.26 (p < 0.001). No postoperative complications occurred, including wound infection, cutaneous nerve injury, or recurrent ankle instability. All patients reported improved ankle stability and returned to daily activities without significant limitation. Conclusion For patients with chronic lateral ankle instability caused by talar-sided anterior talofibular ligament insertion tears, all-arthroscopic knotless anchor repair results in minimal surgical trauma, enables safe and reliable anatomical restoration of the ligament, and yields satisfactory short-term functional outcomes and pain relief. However, given the limitations of the retrospective case series design, including a small sample size and lack of a control group, further prospective studies with larger cohorts are needed to validate its long-term efficacy.