Arthroscopic modified Brostrom procedure achieves faster return to sports than open procedure for chronic ankle instability

Purpose To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Brostrom procedure for chronic lateral ankle instability (CLAI) patients. Methods From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Brostrom procedure (n = 36) and open modified Brostrom procedure (n = 34). They were evaluated at five time points (preoperation and 3 months, 6 months, 1 year and 2 years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications. Results Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 +/- 2.4 weeks vs. 18.7 +/- 3.1 weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3 months and 6 months postoperatively and VAS at 3 months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6 months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups. Conclusions Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6 months postoperatively, and no clinical differences were found between arthroscopic and open modified Brostrom procedure 1 year or 2 years postoperatively. Arthroscopic modified Brostrom procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery. Clinical registration ChiCTR1900023999.