Contralateral Balance Training Improves Postural Control and Functional Recovery After Arthroscopic Anterior Talofibular Ligament Repair: A Prospective, Randomized, Single-Blind Trial

BACKGROUND: Chronic ankle instability (CAI) affects approximately 40% of patients within 1 year after a first-time acute lateral ankle sprain. While arthroscopic anterior talofibular ligament (ATFL) repair is preferred when conservative treatment fails, early postoperative balance training is limited by weight-bearing restrictions. Cross-education, which transfers training benefits from one limb to the contralateral untrained limb, has demonstrated efficacy in improving postural control under conservative care; however, its postoperative utility remains poorly understood. This study investigates whether integrating contralateral balance training into standard rehabilitation enhances functional recovery after ATFL repair. METHODS: This study was conducted at the Sports Medicine Center of West China Hospital, Sichuan University (Chengdu, China) between November 2024 and November 2025. Fifty-eight participants with unilateral CAI undergoing arthroscopic ATFL repair were randomized to an assisted rehabilitation group (ARG, n = 29) or conventional rehabilitation group (CRG, n = 29). Both groups received 6-week standard rehabilitation. The ARG additionally performed progressive contralateral limb balance training three times per week for 6 weeks. Primary and secondary outcomes included static balance (sway velocity), dynamic postural control (Star Excursion Balance Test [SEBT]), sensory integration (Sensory Organization Test [SOT]), and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Scale, Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL] subscale, Foot and Ankle Ability Measure-Sports [FAAM-Sport] subscale, and Tampa Scale for Kinesiophobia [TSK]). RESULTS: Post-intervention, the ARG demonstrated significantly lower eyes-closed sway velocity (P = 0.016) and greater SEBT reach distances in anterior (P = 0.005) and posterolateral (P = 0.018) directions than the CRG. The ARG also achieved superior equilibrium scores during sensory conflict (SOT-3: P < 0.001; SOT-4: P = 0.023). Furthermore, the ARG reported significantly better functional scores than the CRG, including AOFAS and FAAM-ADL, while FAAM-Sport showed relative preservation compared with a significant decline in the CRG. CONCLUSION: Compared with conventional rehabilitation alone, supplemental contralateral balance training resulted in statistically superior postural control under eyes-closed conditions and in selected dynamic balance directions. Improvements in sensory integration (SOT3, SOT4) were statistically significant but did not reach the respective condition-specific MCIDs. This approach appears safe and feasible during early-stage rehabilitation, with the primary effect being attenuation of early postoperative decline.