All-Inside and All-Knotless Soft Tissue Anchor Repair for Chronic Lateral Ankle Instability: A Retrospective Study of a New Surgical Technique

Maria Inês Peixoto; Luís Fabião; Daniel Freitas; Guilherme França; Filipe Malheiro; Bruno S. Pereira

Abstract

Background: Chronic lateral ankle instability (CLAI) is a common pathology among athletes. Although the open modified Broström-Gould procedure remains the gold standard, arthroscopic approaches have gained popularity due to their minimally invasive nature and promising outcomes. Despite growing clinical adoption, evidence on the effectiveness of these techniques - especially those using knotless anchor systems - remains relatively limited.Purpose: This study aims to evaluate the clinical and functional outcomes of arthroscopic repair of CLAI using a knotless anchor system, contributing to the growing body of literature supporting this approach.Methods: We analyzed patients who underwent arthroscopic CLAI repair with a knotless anchor system. Clinical assessments were performed at three time points: preoperatively, and at 6 and 12 months postoperatively. Variables collected included age, sex, Visual Analog Scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Karlsson-Peterson score, patient satisfaction, and surgery-related complications.Results: A total of 36 patients were included (64% male, 36% female), with a mean age of 27.5 ± 8.0 years. Statistically significant improvements were observed in VAS, AOFAS, and Karlsson-Peterson scores at both 6 and 12 months (p < 0.001). The median AOFAS score improved from 61.0 preoperatively to 96.0 at 6 and 12 months. The Karlsson-Peterson score rose from 45.0 to 95.0. At 12 months, 91.7% of patients reported being very satisfied and 8.3% satisfied. Only two minor complications were recorded. No significant correlation was found between outcomes and patient age or sex.Conclusion: Arthroscopic repair of CLAI using a knotless anchor system demonstrates excellent short-term clinical and functional results. These findings support its continued use and encourage further comparative studies with open Broström-Gould procedures and alternative arthroscopic techniques.What this study adds: This study provides retrospective evidence supporting the effectiveness of all-arthroscopic, knotless anchor repair for chronic lateral ankle instability, showing excellent short-term clinical and functional outcomes with high patient satisfaction and low complication rates.Potential impacts on research, practice, or policy: These findings support wider use of arthroscopic knotless anchor techniques in clinical practice and may influence surgical decision-making and future guidelines.Study Design: Retrospective cohort studyLevel of evidence: Level IIIKeywords: Ankle; Ankle arthroscopic repair; Arthroscopy; Chronic lateral ankle instability; Joint; Knotless tissue anchor; Ligament; Minimally invasive surgeryhttps://doi.org/10.70885/hmsj.2026.02.002

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