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

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.