Comparative short-term outcomes of arthroscopic versus open Broström–Gould repair for chronic lateral ankle instability: a randomized study from Mongolia

INTRODUCTION/OBJECTIVES: Chronic lateral ankle instability (CLAI), often resulting from incomplete healing of anterior talofibular ligament (ATFL) injuries, is common among active populations. While open BroströmGould (OBG) repair remains the standard surgical technique, arthroscopic Broström-Gould (ABG) repair has emerged as a minimally invasive alternative. The objective of this randomized comparative study was to compare short-term clinical outcomes and early recovery profiles between ABG and OBG repair in patients with CLAI. METHODS: A randomized comparative clinical study was conducted at the National Trauma and Orthopedic Research Center of Mongolia between June 2023 and June 2025. Fifty patients with magnetic resonance imaging (MRI) confirmed ATFL injuries and clinical instability were randomized to undergo either ABG (n = 25) or OBG (n = 25) repair. Functional outcomes were assessed using the anterior drawer test (ADT), visual analog scale for pain, Tegner activity score, Karlsson-Peterson (K-P) score, and American Orthopaedic Foot and Ankle Society (AOFAS) score at 6, 12, and 24 months, postoperatively. Statistical analyses included independent t tests, analysis of covariance, and difference-in-differences analysis. RESULTS: Both groups demonstrated statistically significant improvements in all clinical outcome measures at final follow-up (p < 0.001). At 24 months, no statistically significant differences were observed between groups in mechanical stability or functional scores. However, the ABG group reported statistically significantly lower pain scores at 24 months (2.88 ± 0.97 vs 3.72 ± 0.68; p = 0.001) and superior early recovery in functional scores at 6 months. The early functional advantage observed after arthroscopic repair was associated with a large effect size (Cohen's d), indicating a clinically meaningful early functional benefit. Postoperative complication rates were low and did not differ statistically significantly between groups. CONCLUSION: Both ABG and OBG repair techniques provide comparable short-term clinical and functional outcomes for CLAI. Arthroscopic repair offers advantages in early recovery and pain reduction, supporting its use as an effective alternative in appropriately selected patients. LEVEL OF EVIDENCE: Level I, randomized comparative clinical study.