All-inside arthroscopic capsular plication shows favorable outcomes in patients with chronic lateral ankle instability and irreparable anterior talofibular ligament

Background In chronic lateral ankle instability (CLAI) and irreparable anterior talofibular ligament (ATFL), reconstruction procedures are commonly advocated. All-inside arthroscopic capsular plication may be a viable alternative for CLAI in patients with an unrepairable ATFL. Source of data A retrospective study was conducted between 2016 and 2021 on 92 consecutive CLAI patients with arthroscopically confirmed unrepairable ATFL who underwent all-inside arthroscopic surgery. Patients were divided into two groups: in the reconstruction group (n = 40), an autologous gracilis tendon was used to reconstruct the lateral ligament complex; in the plication group (n = 52), the lateral ankle capsule was plicated using a double-loaded suture anchor. Areas of agreement Restoring lateral ankle stability is the optimal goal in the management of CLAI. Areas of controversy The reliability of all-inside arthroscopic capsular plication for CLAI with an irreparable ATFL compared with reconstruction procedures remains uncertain. Growing points Over 2 years of follow-up, the plication group achieved superior American Orthopedic Foot and Ankle Society scores at 3 months and 1 year, and higher Karlsson Ankle Functional scores at 1 and 2 years, whereas the reconstruction group demonstrated better anterior talar translation scores; ankle joint position sense was comparable between groups. Areas timely for developing research Biomechanical comparisons between the two procedures are urgently needed.