To explore the clinical effect of anterior talofibular ligament (ATFL) repair using ankle arthroscopic all-inside technique with modified anteromedial midline and auxiliary anterolateral portals.

The data of 38 patients admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from Jul. 2021 to May 2022 due to ATFL injuries were retrospectively analyzed. The injury time was 3-36 months, with an average of (18.47±8.74) months. All patients had indications for surgery, and the ATFL was repaired with an anchor by using arthroscopic all-inside technique with modified anterior double portals. The clinical outcome was evaluated by follow-up VAS pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle function scores, ankle stability (anterior drawer test), and complications (wound healing, vascular and nerve injury, ligament re-rupture, and infection).

All 38 patients underwent successful surgery and were followed up for 6-16 months. All the surgical incisions healed at stage I, and no complications such as infection, vascular and nerve injury, and ligament re-rupture occurred. All the patients obtained good ankle joint stability after physical examination, and the anterior drawer test was negative. The VAS score at the last follow-up was (1.02±0.92) points, which was significantly lower than that before surgery (5.66±1.02) points, and the difference was statistically significant (P< 0.05). The AOFAS score at the last follow-up was (91.29±3.98) points, which was significantly better than that before surgery (52.47±7.61) points, and the difference was statistically significant (P<0.05).

Arthroscopic all-inside ATFL repair with modified anterior double-portals has the advantages of minimal invasion, reliable, clear field of vision and simple operation, and can obtain satisfactory clinical results, significantly improving the function and stability of the ankle joint.