Does the early advantage of arthroscopic Broström repair persist? A systematic review and meta-analysis of time-specific outcomes and complication profiles

Previous meta-analyses have reported early functional and recovery advantages after arthroscopic Broström repair for chronic lateral ankle instability (CLAI), but whether these differences persist at later follow-up remains uncertain. Heterogeneous follow-up handling and aggregate reporting of procedure-related complications have also limited interpretation of the timing and safety profile of any arthroscopic advantage. We therefore compared arthroscopic and open anatomic lateral ligament repair using time-specific functional outcomes and clinically distinct complication categories, together with mechanical stability and recurrent instability. PubMed, Embase, and Web of Science were searched from inception to August 31, 2026. Randomized controlled trials (RCTs) and nonrandomized comparative studies of arthroscopic versus open Broström/Broström-Gould or equivalent anatomic repair were included. Functional outcomes were pooled at prespecified 6-, 12-, and 24-month assessments as explicitly reported by the original studies where sufficient data were available. Procedure-related adverse events were analyzed overall and according to wound/incision, neurologic, and suture/knot/anchor-related categories. Random-effects models used restricted maximum likelihood estimation with Hartung–Knapp inference. RCT-only and leave-one-out sensitivity analyses were performed. Eighteen studies, including 5 RCTs, comprising 1,102 operated ankles (564 arthroscopic and 538 open) were included. AOFAS scores favored arthroscopic repair at 6 months (mean difference [MD], 4.35; 95% CI, 1.33–7.37), but not at 12 months (MD, 1.17; 95% CI, − 2.02 to 4.35) or 24 months (MD, 0.65; 95% CI, − 1.97 to 3.26). When restricted to RCTs, the 6-month point estimate remained similar but was substantially less precise (MD, 4.25; 95% CI, − 2.72 to 11.22). VAS pain scores did not differ significantly at 6 or 12 months. Overall procedure-related adverse events were similar between techniques (RR, 0.86; 95% CI, 0.58–1.29), whereas wound- and incision-related complications were less frequent after arthroscopic repair (RR, 0.33; 95% CI, 0.13–0.79). Neurologic complications (RR, 1.47; 95% CI, 0.79–2.73) and suture-, knot-, and anchor-related complications (RR, 0.84; 95% CI, 0.29–2.43) did not differ significantly. No significant differences were detected in recurrent instability, anterior talar translation, or talar tilt. The early functional advantage associated with arthroscopic Broström repair was not consistently maintained at later follow-up. Arthroscopy was also associated with lower wound- and incision-related morbidity, but not with lower overall or neurologic complication rates. The similar 6-month point estimate but wider confidence interval in the RCT-only analysis indicates that the magnitude of the early functional benefit remains uncertain. Overall, current evidence suggests that arthroscopy may modify the early postoperative course and reduce wound morbidity without demonstrating sustained functional or overall superiority over open repair.