Published online Dec 18, 2025. doi: 10.5312/wjo.v16.i12.114166
Revised: September 27, 2025
Accepted: October 28, 2025
Published online: December 18, 2025
Processing time: 95 Days and 7.8 Hours
The anterior talofibular ligament (ATFL) is the most commonly injured ligament in ankle sprains. While most individuals recover with conservative management, some patients develop persistent pain and instability from chronic ATFL tears. Surgical repair is often required, and minimally invasive techniques are gaining popularity.
To evaluate the clinical outcomes of a novel, totally percutaneous (TP) modified Broström repair (MBR) for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.
This retrospective study analyzed 20 patients (14 males, 6 females; mean age, 28.7 years) who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center. All patients had persistent pain and instability for at least 3 months despite conservative treatment. Diagnosis was confirmed by magnetic resonance imaging, arthroscopy, and stress testing. TP-MBR was performed using suture anchors and percutaneous ligament advancement. Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.
All procedures were completed successfully with no intraoperative complications. At a mean follow-up of 1.5 years, patients showed significant improvements in American Orthopaedic Foot and Ankle Society score (from 39.85 to 84.4; P < 0.001) and Karlsson scores (from 43.8 to 87.4; P < 0.001). All patients returned to pre-injury activity levels with resolution of instability. The technique resulted in minimal tissue trauma, reduced operative time, accelerated recovery, and excellent cosmetic outcomes. No recurrences or major complications occurred.
TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears. It offers the benefits of a minimally invasive approach, including less trauma and faster rehabilitation, making it a valuable option for appropriately selected patients.
Core Tip: The totally percutaneous modified Broström repair preceded by diagnostic ankle arthroscopy and confirmed by intraoperative stress views, offers a safe and effective minimally invasive alternative for chronic anterior talofibular ligament tears unresponsive to at least 3 months of conservative management. This technique minimizes soft tissue trauma, reduces operative time, and promotes faster recovery with excellent cosmetic and functional outcomes, making it particularly beneficial for active patients aiming for a quicker return to sports and daily activities. This case series demonstrates significant improvement in functional scores and resolution of instability at 18-month follow-up, highlighting its potential as a preferred surgical option.