Meta-analysis of surgical approaches to lateral ankle instability: Open Broström versus arthroscopic Broström versus lasso-loop repair

Thomas Cho; Colin Jones; Shaza Chaudry; Jiayong Liu

doi:10.1016/j.jor.2026.02.014

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74 (); 323-331

doi:

10.1016/j.jor.2026.02.014

Meta-analysis of surgical approaches to lateral ankle instability: Open Broström versus arthroscopic Broström versus lasso-loop repair

Thomas Cho, Colin Jones, Shaza Chaudry, Jiayong Liu

Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, USA

⁎Corresponding author: Jiayong Liu. jiayong.liu@utoledo.edu

Received: 2025-12-27, Accepted: 2026-2-2, Published: 2026-2-3

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Anterior talofibular ligament (ATFL) injury is a common cause of chronic lateral ankle instability and is more frequent among those who are active and play sports. There are multiple techniques to repair the ATFL, including the historically gold-standard Open Bröstrom (OB) technique, the Arthroscopic Bröstrom (AB) technique, and the more novel arthroscopic Lasso-Loop (LL) technique. This meta-analysis seeks to compare outcome statistics of these techniques for ATFL repair.

A literature search was conducted on PubMed and Embase for comparison studies or randomized controlled trials that included at least two of the surgical techniques and at least one relevant functional outcome or complication statistic up until October 2025. Statistical analyses were performed using Review Manager Web, and a P-value ≤0.05 was considered statistically significant.

1426 patients across 21 studies were included in this analysis. When compared to OB, AB had a significantly lower post-operative Visual Analog Scale (VAS) score (P = 0.01), higher Karlsson score (P < 0.001), higher American Orthopaedic Foot and Ankle Society (AOFAS) score (P = 0.003), and shorter time to return to daily work (P = 0.02). Compared to OB, LL had a significantly lower VAS score (P < 0.001) and higher AOFAS score (P = 0.02). However, OB had a lower rate of range of motion (ROM) restriction (P = 0.002) and shorter time to return to running (P = 0.01) when compared to LL. No significant results were found comparing AB and LL.

This study found that AB had a significantly lower VAS score, significantly higher Karlsson and AOFAS scores, and significantly shorter time to return to daily work compared to OB. LL also had significantly lower VAS and significantly higher AOFAS scores compared to OB. However, OB had a significantly lower risk of ROM restriction and significantly shorter time to return to running than LL. The minimally invasive AB and LL techniques seem to be the superior treatment methods for ATFL injuries when compared to OB repair, with no clinically significant differences seen between the two.

Keywords

Ankle instability

Anterior talofibular ligament

Bröstrom

Lasso-loop

Outcomes

Show Related Articles from PubMed

1 Introduction

In sports, ankle sprains are an incredibly common injury, with tens of thousands of sprains occurring daily in the United States.¹ In these sprains, the anterior talofibular ligament (ATFL) is most frequently implicated, injured in 77% of sprains. Overall, half of all ATFL injuries occur in athletes who are frequently active, especially those who play basketball or football.² Conservative management is indicated in most ATFL injuries.¹ While there are many conservative modalities, the core of conservative ATFL treatment, as with other soft tissue injuries, is the “peace and love” principle.² This principle is built on the acronym PEACE and LOVE, standing for Protect, Elevate, Avoid anti-inflammatory modalities, Compress, Educate, Load, Optimism, Vascularization, and Exercise. Conservative management can cover many patients, but up to 1-in-5 may still require surgical intervention.¹

Operative repair in ATFL injuries is built on the foundation of the modified Bröstrom-Gould procedure. Building upon the original Bröstrom technique, which involves suturing the ATFL and calcaneofibular ligaments end-to-end and anchoring the ATFL to the anterior fibula, the Bröstrom-Gould procedure incorporates the inferior extensor retinaculum.³ The Bröstrom-Gould procedure has historically been performed “open”, such that an incision allows visualization of the ankle joint over the distal aspect of the fibula (Fig. 1A–C). More recently, an arthroscopic Bröstrom-Gould procedure has been developed, in which the procedure remains functionally the same, besides a much smaller incision and visualization via an arthroscope (Fig. 2).³ Literature has frequently shown that open and arthroscopic Bröstrom-Gould procedures have similar outcomes.³

A–C. Illustration of open Bröstrom repair.

Illustration of arthroscopic Bröstrom repair.

There is, however, a literary gap regarding comparisons between the two versions of the Bröstrom-Gould procedure and ATFL repair involving a Lasso-Loop (LL) suture technique. The LL technique is a particular variation on the classic arthroscopic Bröstrom (AB) technique. It involves the use of a self-cinching lasso-loop stitch which has been shown to have superior tissue-holding strength compared to non-self-cinching stitches.⁴ Specifically, a nylon thread is passed into the ATFL remnant, rotated in opposite directions, and one end of an anchor suture is passed through the nylon loop. The nylon loop pulls the mid-portion of the anchor suture through the ATFL, forming a loop of suture, through which the free end of the suture is passed (Fig. 3). This creates the self-cinching stitch.⁴

There is an unfortunate lack of comparison studies between the LL technique and the AB and Open Bröstrom (OB) techniques. This meta-analysis seeks to compile the literature that does exist to determine the efficacy of these ATFL repair techniques to allow orthopedic surgeons to choose the technique with the most optimal outcomes.

2 Methods

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline was used for this study.⁵

2.1

2.1 Study search

Studies were searched on PubMed and Embase from September 30, 2025, through October 15, 2025. The keywords “bröstrom”, “arthroscopic”, “lasso-loop”, and “ankle” were utilized for the initial searches. Search criteria were then narrowed to only include cohort studies or randomized controlled trials (RCTs).

2.2

2.2 Inclusion and exclusion criteria

Studies were eligible for this meta-analysis if they were cohort studies or RCTs that compared at least two of the interested surgical techniques and reported at least one target outcome. Target outcomes included visual analogue score (VAS), Karlsson ankle score, American Orthopaedic Foot and Ankle Society (AOFAS) score, average operative time (minutes), average time to return to daily work (weeks), average time to return to running (weeks), incidence of range of motion (ROM) restriction, and incidence of infection. Articles that did not meet the inclusion criteria mentioned above and/or were meta-analyses, review articles, biomechanical studies, case reports, or where full texts were not readily available were excluded from this study. Unfortunately, the authors were not able to find any studies that compared OB to LL. To account for this, the authors pooled data from studies that had an OB group and from studies that had a LL group into a “Combined studies” group in order to carry out this statistical analysis. This was done in accordance with methods outlined in the Cochrane handbook.⁶

2.3

2.3 Assessment of study quality

After the independent application of the inclusion and exclusion criteria by each author for all retrieved studies, assessment of study quality was carried out. For RCTs, the Cochrane Risk of Bias Tool was used, which consists of scoring each study as a low risk, unclear risk, or high risk of bias for each of the following parameters: random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other bias.⁷ This was done using the Reviewer Manager Web software. The Newcastle-Ottawa scale was applied to all remaining non-randomized studies.⁸

2.4

2.4 Data retrieval

The following data was retrieved and stored in an excel sheet: first author, publication date, journal, type of study, surgical treatment groups, number of patients, target outcomes. Follow-up times were variable among the included studies. Therefore, this study only included data for post-operative functional outcomes with a minimum follow-up time of 12 months. Of note, some of the studies in our analysis involve a pure Bröstrom repair, rather than the previously specified modified Bröstrom-Gould repair. However, literature has shown that the Bröstrom and Bröstrom-Gould repairs restore effective mechanical stability, with the Bröstrom-Gould technique only conferring marginal increases in tissue strength over the Bröstrom repair.⁹ Therefore, we chose to include both the Bröstrom-Gould and Bröstrom techniques in the OB category when comparing them to the other techniques.

2.5

2.5 Statistical analysis

Review Manager Web was used to execute all statistical analyses for this study. Mean ± standard deviation (SD) was used to present continuous variables, while event rate was used to present dichotomous variables. For continuous variables, an inverse variance method with a mean difference (MD) was used, while for dichotomous variables, a Mantel-Haenszel method with risk ratio (RR) was used. To assess the heterogeneity of each analysis, the I² statistic was used with the following interpretation: 0%–40% (might not be necessary), 30%–60% (may represent moderate heterogeneity), 50%–90% (may represent substantial heterogeneity), and 75%–100% (considerable heterogeneity).¹⁰ If I² ≤ 50%, a fixed effect analysis model was used. If I² > 50%, a random effects analysis model using the DerSimonian and Laird and Wald-type confidence interval (CI) methods was used. A P-value ≤0.05 was considered statistically significant, and significant results were presented as a forest plot with a 95% CI.

3 Results

3.1

3.1 Summary of included studies

21 studies were ultimately included in this meta-analysis study, with 18 of these being a retrospective cohort study, one being a prospective cohort study, and two being a RCT (Fig. 4)0.^11–31 A total of 1426 patients were included, with 627 in the OB group, 738 in the AB group, and 61 in the LL group (Table 1).

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.

Table 1 Summary of study characteristics.

Author (Date)	Journal	Study type	OB	AB	LL	Outcomes
Baek (2023)¹¹	Knee Surg Sports Traumatol Arthrosc.	RCS	34	31	N/A	Karlsson, AOFAS, Infection
Guelfi (2023)¹²	Knee Surg Sports Traumatol Arthrosc.	RCS	41	49	N/A	AOFAS, ROM restriction, Infection
Guo (2023)¹³	Knee Surg Sports Traumatol Arthrosc.	RCS	N/A	29	29	VAS, Karlsson, Operative time, ROM restriction
Hou (2022)¹⁴	Knee Surg Sports Traumatol Arthrosc.	RCT	34	36	N/A	AOFAS, Time to return to running, ROM restriction, Infection
Kim (2024)¹⁵	Clin Orthop Surg	RCS	17	37	N/A	VAS, AOFAS, Infection
Lee (2024)¹⁶	Medicina (Kaunas)	RCS	30	30	N/A	Time to return to running
Li (2017)¹⁷	Am J Sports Med	RCS	37	23	N/A	Karlsson, AOFAS, ROM restriction, Infection
Liu (2024)¹⁸	Knee Surg Sports Traumatol Arthrosc.	RCS	N/A	42	32	Karlsson, AOFAS, Time to return to daily work, Time to return to running, ROM restriction, Infection
Nakasa (2024)¹⁹	J Foot Ankle Surg	RCS	23	40	N/A	Karlsson, AOFAS
Rigby (2019)²⁰	Foot Ankle Surg	RCS	32	30	N/A	Infection
Su (2021)²¹	Med Sci Monit	RCS	40	40	N/A	Karlsson, AOFAS, Operative time, Infection
Wang (2023)²²	Knee Surg Sports Traumatol Arthrosc.	PCS	31	30	N/A	VAS, Karlsson, AOFAS, Time to return to daily work, ROM restriction, Infection
Wang (2023)²³	Front Surg	RCS	50	49	N/A	VAS, Karlsson, AOFAS, Operative time, Infection
Woo (2020)²⁴	Foot Ankle Int	RCS	26	26	N/A	VAS, AOFAS, Infection
Xu (2020)²⁵	J Orthop Surg Res.	RCS	35	32	N/A	VAS, Karlsson, AOFAS, Infection
Xu (2025)²⁶	PLoS One	RCS	60	58	N/A	AOFAS, Operative time
Yang (2024)²⁷	Int Orthop	RCS	28	23	N/A	VAS, AOFAS
Yeo (2016)²⁸	Foot & Ankle International	RCT	23	25	N/A	VAS, Karlsson, AOFAS
Zeng (2020)²⁹	Foot & Ankle International	RCS	10	17	N/A	Karlsson, AOFAS, Operative time
Zhao (2025)³⁰	Foot Ankle Surg	RCS	40	60	N/A	Karlsson, AOFAS, Operative time, Infection
Zhou (2021)³¹	Arthroscopy	RCS	36	31	N/A	VAS, Karlsson, AOFAS, Infection

3.2

3.2 Patient-reported outcomes

Regarding VAS, significant differences were found in favor of AB compared to OB (MD = 0.17; 95% CI: 0.04 to 0.30; P = 0.01; Fig. 5A) and in favor of LL compared to OB (MD = 1.32; 95% CI: 1.03 to 1.61; P < 0.001; Fig. 5B). No significant difference was found between AB and LL groups (MD = 0.20 95% CI: −0.22 to 0.62; P = 0.36).

Forest plots showing significant results for VAS scores, including (A) OB vs AB repair, (B) OB vs LL repair.

Regarding the Karlsson score, a significant difference was found in favor of AB compared to OB (MD = −1.18; 95% CI: −1.87 to −0.50; P < 0.001; Fig. 6) while no significant differences were found between AB and LL (MD = 1.50; 95% CI: −1.84 to 4.85; P = 0.38) and OB and LL groups (MD = −1.97; 95% CI: −4.80 to 0.86; P = 0.17).

Forest plot showing significant result for Karlsson score between AB and OB repair groups.

Regarding AOFAS score, significant differences were found in favor of AB compared to OB (MD = −1.83; 95% CI: −3.02 to −0.63; P = 0.003; Fig. 7A) and in favor of LL compared to OB (MD = −3.56; 95% CI: −6.45 to −0.67; P = 0.02; Fig. 7B). No significant difference was found between AB and LL groups (MD = 0.10; 95% CI: −3.80 to 4.00; P = 0.96).

Forest plots showing significant results for AOFAS scores, including (A) OB vs AB repair, (B) OB vs LL repair.

3.3

3.3 Perioperative outcomes

Regarding average operative time, no significant differences were found between OB and AB (MD = 6.75; 95% CI: −0.63 to 14.14; P = 0.07), AB and LL (MD = 1.80; 95% CI: −5.59 to 9.19; P = 0.63), and OB and LL groups (MD = 4.04; 95% CI: −0.98 to 9.06; P = 0.11).

Regarding average time to return to daily work, a significant difference was found in favor of AB compared to OB (MD = 1.30; 95% CI: 0.17 to 2.43; P = 0.02; Fig. 8) while no significant differences were found between AB and LL (MD = 1.70; 95% CI: −1.81 to 5.21; P = 0.34) and OB and LL groups (MD = −1.80; 95% CI: −4.24 to 0.64; P = 0.15).

Forest plot showing significant result for average time to return to daily work between AB and OB repair groups.

Regarding average time to return to running, a significant difference was found in favor of OB compared to LL (MD = −5.59; 95% CI: −9.99 to −1.19; P = 0.01; Fig. 9) while no significant differences were found between OB and AB (MD = −0.44; 95% CI: −2.13 to 1.25; P = 0.61) and AB and LL groups (MD = −0.30; 95% CI: −4.39 to 3.79; P = 0.89).

Forest plot showing significant result for average time to return to running between OB and LL repair groups.

3.4

3.4 Complications

Regarding ROM restriction, a significant difference was found in favor of OB compared to LL (RR = 0.09; 95% CI: 0.02 to 0.43; P = 0.002; Fig. 10) while no significant differences were found between OB and AB (RR = 1.00; 95% CI: 0.18 to 5.53; P = 1.00) and AB and LL groups (RR = 1.12; 95% CI: 0.53 to 2.36; P = 0.76).

Forest plot showing significant result for rate of ROM restriction between OB and LL repair groups.

Regarding infection rate, no significant differences were found between OB and AB (RR = 2.44; 95% CI: 0.71 to 8.35; P = 0.15), AB and LL (0 events for both groups), and OB and LL groups (RR = 1.24; 95% CI: 0.07 to 20.94; P = 0.88).

4 Discussion

Ankle sprains with injury to the ATFL are very common, especially among athletes. Although most patients pursue a conservative treatment route, some still require surgical intervention. OB and AB techniques are the most commonly used surgical techniques to treat these injuries, with LL being an alternative arthroscopic technique that can be utilized. The results of this study show LL to be a viable alternative in the treatment of ATFL injuries.

Overall, this meta-analysis found AB and LL surgical techniques to have better patient-reported outcomes compared to OB. For VAS, this study found that both AB and LL had significantly lower scores compared to OB, while no significant difference was seen between AB and LL groups. Meta-analysis studies in the literature have shown AB to be more advantageous compared to OB in this regard, although other studies have shown no significant differences, particularly in the long-term of over 2 years post-operation.^32–36 For the Karlsson score, this study found AB to have a higher score compared to OB, with no significant differences found between AB and LL and OB and LL. Similar to VAS, some of the current literature agrees with the finding of AB having a higher Karlsson compared to OB, while other studies have shown no significant differences, with benefits seeming to taper off in the long term.¹^,^32–36 AOFAS was found to be higher in the AB group compared to OB and in the LL group compared to OB, with no significant difference found between AB and LL groups. Similarities are seen again, with some meta-analyses showing a significance difference in favor of AB compared to OB while others do not.¹^,^32–37 Minimally invasive techniques tend to result in lower post-operative pain, most likely due to reduced soft tissue trauma, thus it is highly probable that this is why the AB and LL groups generally showed better patient-reported outcomes compared to the open procedure. No differences were found between the two minimally invasive techniques, showing that both AB and LL techniques can be used to adequately reduce post-operative pain and increase patient satisfaction.

This study found no significant differences in average operative time between any of the three groups. The meta-analysis by Zhao et al. also found no significant difference.³⁵ In regard to the average time to return to daily work, this study found that the AB group had a faster return compared to OB, with no significant differences found between AB and LL and OB and LL. The authors could not find meta-analyses that reported this outcome, thus presenting a new finding. As previously discussed, the minimally invasive nature of arthroscopy typically results in less tissue trauma and reduced post-operative pain. It is reasonable that this combination would lead to a faster functional recovery and ability to go back to work. This study found that the OB group had a faster return to running compared to LL, with no significant differences seen between the other groups. This was an unexpected result, as the authors expected the minimally invasive techniques to be superior in this outcome. Although no meta-analyses have specifically compared the return to running, one study found that the AB group had a faster time to weightbearing but found no significant difference between OB and AB in average time to return to sports.³⁵ The authors hypothesize that this result could have been due to confounding factors such as differences in rehabilitation protocols. Due to the LL repair being a more recent addition to ATFL treatment management, patients might have had stricter post-operative restriction compared to OB, which could have delayed return to sports and running.

This study found that the OB group had a lower rate of ROM restriction compared to the LL group, with no significant differences seen between OB and AB and AB and LL groups. The authors believe that although the LL technique may be effective for stabilization, it may result in ROM restriction due to its suture configuration. The LL method could potentially overtight the ATFL or alter the anatomical length, potentially resulting in a stiffer repair. Studies have shown that it might not be possible for complete observation of the ATFL attachment site during arthroscopic surgery.³⁸^,³⁹ Biomechanical studies have shown that non-anatomical repair has an impact on ankle kinematics and can restrict joint motion, thus providing a potential explanation for this finding.^40–42 This study found no significant differences in infection rate between all three groups. Meta-analyses by Zhi et al. and Brown et al. found similar findings.¹^,³⁶ One study did find that the AB group had a lower rate of wound-related complications compared to OB. However, this outcome encompassed wound infection alongside instances of wound irritation and poor wound healing.³²

This study was not without its limitations. The authors believe that the most significant limitation was the difference in sample sizes. Due to the limited literature regarding comparison studies with LL repair, the LL sample size in this study was only 61 patients, while there were 627 in the OB group and 738 in the AB group. Although this was a sizable difference, the authors believe the results of this study still provide novel findings on this topic and that the methodology of conducting a meta-analysis can make up for this deficit. There was some subjectivity in the outcomes of average time to return to work and the incidence of ROM restriction. The two studies that reported return to work did not specifically define this outcome in the methods section, thus possibly reducing the clarity and consistency of the results.¹⁸^,²² Additionally, the specific definition of ROM restriction was not clearly defined in all of the studies that reported this outcome. The authors realize this could introduce potential bias in the interpretation of the results. However, with the limited amount of data available in the literature, these outcomes were still included in order to provide a comprehensive review. Lastly, this meta-analysis mostly consisted of cohort studies. Limitations of this could include greater risk of bias and confounding, lower internal validity, and inconsistent outcome definitions.

5 Conclusion

Both AB and LL techniques had superior patient-reported outcomes compared to the OB treatment group, showcasing the advantages of minimally invasive surgery. However, this study found that OB had a lower rate of ROM restriction and a shorter time to return to running compared to the LL group, and no significant differences found between AB and LL groups. The minimally invasive techniques seem to overall provide better outcomes for patients undergoing ATFL repair compared to the open technique. However, additional comparison studies including LL repair as a treatment group with adequate sample sizes and high-quality methodology should be conducted before labeling a specific surgical technique as the gold standard treatment for ATFL injuries.

Potential conflicts of interest and funding sourcesauthor-disclosure

None are declared.

CRediT author statement

Thomas Cho: Data curation; Formal analysis; Investigation; Methodology; Resources; Writing – original draft; Writing – review & editing.

Colin Jones: Data curation; Investigation; Methodology; Writing – review & editing.

Shaza Chaudry: Data curation; Investigation; Methodology; Writing – review & editing.

Jiayong Liu: Conceptualization; Formal analysis; Investigation; Methodology; Project administration; Resources; Validation; Writing – original draft; Writing – review & editing.

Ethical statements

We confirm that all authors have read and approved the manuscript, and no other individuals meet the authorship criteria but are not listed. We have also agreed upon the order of authorship as presented. Furthermore, we assure you that this manuscript has not been submitted elsewhere.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Moorthy V., Sayampanathan A.A., Yeo N.E.M., Tay K.S., . Clinical outcomes of open versus arthroscopic brostrom procedure for lateral ankle instability: a meta-analysis. J Foot Ankle Surg. May-Jun 2021;60(3):577-584.
[Google Scholar]
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Tonsuthanluck S., Handoyo H.R., Tharincharoen R., Angthong C., . Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. Eur J Orthop Surg Traumatol. Apr 2024;34(3):1487-1495.
[Google Scholar]
Zhao B., Sun Q., Xu X., et al . Comparison of arthroscopic and open brostrom-gould surgery for chronic ankle instability: a systematic review and meta-analysis. J Orthop Surg Res. Nov 14 2023;18(1):866.
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Zhi X., Lv Z., Zhang C., Kong C., Wei S., Xu F., . Does arthroscopic repair show superiority over open repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review and meta-analysis. J Orthop Surg Res. Aug 26 2020;15(1):355.
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[Google Scholar]
Teramoto A., Shoji H., Sakakibara Y., Suzuki T., Watanabe K., Yamashita T., . The distal margin of the lateral malleolus visible under ankle arthroscopy (articular tip) from the anteromedial portal, is separate from the ATFL attachment site of the fibula: a cadaver study. J Orthop Sci. May 2018;23(3):565-569.
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Thes A., Klouche S., Ferrand M., Hardy P., Bauer T., . Assessment of the feasibility of arthroscopic visualization of the lateral ligament of the ankle: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. Apr 2016;24(4):985-990.
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Shoji H., Teramoto A., Sakakibara Y., et al . Kinematics and laxity of the ankle joint in anatomic and Nonanatomic Anterior Talofibular Ligament repair: a biomechanical cadaveric Study. Am J Sports Med. Mar 2019;47(3):667-673.
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Show Sections

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[Google Scholar]

[31] Zhou Y.F., Zhang Z.Z., Zhang H.Z., Li W.P., Shen H.Y., Song B., . All-inside arthroscopic modified brostrom technique to repair anterior talofibular ligament provides a similar outcome compared with open brostrom-gould procedure. Arthroscopy. Jan 2021;37(1):268-279.
[Google Scholar]

[32] Moorthy V., Sayampanathan A.A., Yeo N.E.M., Tay K.S., . Clinical outcomes of open versus arthroscopic brostrom procedure for lateral ankle instability: a meta-analysis. J Foot Ankle Surg. May-Jun 2021;60(3):577-584.
[Google Scholar]

[33] Song Y.J., Hua Y.H., . Similar outcomes at early term after arthroscopic or open repair of chronic ankle instability: a systematic review and meta-analysis. J Foot Ankle Surg. Mar 2019;58(2):312-319.
[Google Scholar]

[34] Tonsuthanluck S., Handoyo H.R., Tharincharoen R., Angthong C., . Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. Eur J Orthop Surg Traumatol. Apr 2024;34(3):1487-1495.
[Google Scholar]

[35] Zhao B., Sun Q., Xu X., et al . Comparison of arthroscopic and open brostrom-gould surgery for chronic ankle instability: a systematic review and meta-analysis. J Orthop Surg Res. Nov 14 2023;18(1):866.
[Google Scholar]

[36] Zhi X., Lv Z., Zhang C., Kong C., Wei S., Xu F., . Does arthroscopic repair show superiority over open repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review and meta-analysis. J Orthop Surg Res. Aug 26 2020;15(1):355.
[Google Scholar]

[37] Tsai C.S., Huang M.T., Jou I.M., Wu P.T., Ko P.Y., . Arthroscopic modified Brostrom may improve function while anatomic reconstructions could enhance stability for chronic lateral ankle instability: a network meta-analysis. Foot Ankle Surg. Dec 2024;30(8):630-642.
[Google Scholar]

[38] Teramoto A., Shoji H., Sakakibara Y., Suzuki T., Watanabe K., Yamashita T., . The distal margin of the lateral malleolus visible under ankle arthroscopy (articular tip) from the anteromedial portal, is separate from the ATFL attachment site of the fibula: a cadaver study. J Orthop Sci. May 2018;23(3):565-569.
[Google Scholar]

[39] Thes A., Klouche S., Ferrand M., Hardy P., Bauer T., . Assessment of the feasibility of arthroscopic visualization of the lateral ligament of the ankle: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. Apr 2016;24(4):985-990.
[Google Scholar]

[40] Purevsuren T., Batbaatar M., Khuyagbaatar B., Kim K., Kim Y.H., . Comparative evaluation between anatomic and nonanatomic lateral ligament reconstruction techniques in the ankle joint: a computational study. J Biomech Eng. Jun 1 2018;140(6)
[Google Scholar]

[41] Sakakibara Y., Teramoto A., Takagi T., et al . Effect of initial graft tension during anterior talofibular ligament reconstruction on ankle kinematics, laxity, and in situ forces of the reconstructed graft. Am J Sports Med. Mar 2020;48(4):916-922.
[Google Scholar]

[42] Shoji H., Teramoto A., Sakakibara Y., et al . Kinematics and laxity of the ankle joint in anatomic and Nonanatomic Anterior Talofibular Ligament repair: a biomechanical cadaveric Study. Am J Sports Med. Mar 2019;47(3):667-673.
[Google Scholar]

Meta-analysis of surgical approaches to lateral ankle instability: Open Broström versus arthroscopic Broström versus lasso-loop repair

Abstract