Arthroscopic vs open Broström-Gould repair of the anterior talofibular ligament: a systematic review and meta-analysis of clinical outcomes

Background: This systematic review and meta-analysis aimed to compare clinical outcomes of arthroscopic versus open surgery for anterior talofibular ligament (ATFL) repair in patients with chronic ankle instability. The modified Broström-Gould (MBG) procedure is the most commonly practiced surgical method for chronic lateral ankle instability (CLAI). Arthroscopic MBG is an alternative to the traditional open repair. Methods: A comprehensive search of five databases (PubMed, ScienceDirect, LILACS, Cochrane, and ProQuest) from 1 January 2010 to 30 May 2025 identified 395 articles, with the last search conducted on 30 May 2025. Following the PRISMA guidelines, a systematic review and meta-analysis were performed, including 13 comparative studies (800 patients) comprising randomized controlled trials, cohort studies, and observational designs. The analyzed outcomes included pain (Visual Analogue Scale, VAS), functional recovery (American Orthopaedic Foot and Ankle Society score, AOFAS), and surgical duration. Results: Both arthroscopic and open modified Broström-Gould (MBG) techniques significantly improved pain and function. The arthroscopic approach demonstrated shorter operative times (mean difference -12.4 minutes; p = 0.02; range 25–74 minutes vs. 43 minutes for open surgery) and better short-term recovery at 6-month follow-up, while long-term outcomes were comparable between groups. Meta-analysis of 557 patients (VAS) and 697 patients (AOFAS) revealed no significant intergroup differences [VAS effect size −0.39 (95% CI: −1.15 to 0.37; I2 = 92%); AOFAS effect size 1.65 (95% CI: −0.82 to 4.11; I2 = 87%)]. A few transient neuropathies were reported, occurring slightly more often in arthroscopic cases, but overall complication rates were low and minor. Conclusion: Arthroscopic MBG achieves pain and functional outcomes comparable to open MBG, with shorter operative time and faster early recovery, without an increase in complications. Larger studies are needed to validate these findings.