• Full Name: MANDEEP G ACHAR
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

• Full Name: SANJAY A K
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

• Full Name: SAI ADITHYA RAMAN
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

• Full Name: SURESH PERUMAL
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

• Full Name: THIAGARAJAN K A
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

• Full Name: ARUMUGAM S
• Affiliation/Institution: SRI RAMACHANDRA CENTRE FOR SPORTS SCIENCE
• Country: India

Background:
Lateral ankle sprains are among the most common injuries in football, with repetitive injury often leading to Chronic Lateral Ankle Instability (CLAI), sometimes requiring surgical intervention. While the Modified Broström-Gould (MBG) procedure is considered a gold standard approach, all-arthroscopic techniques are a novel and minimally invasive surgical solution.

Objectives:
This study aims to compare the clinical, functional, and Return to Play (RTP) outcomes of mini-open MBG repair versus all-arthroscopic ATFL repair specifically within a population of elite Indian footballers.

Study design:
16 professional Indian footballers (mean age 23.8 +/-3.5 years) suffering from symptomatic CLAI were divided into two groups: Group A (n=8) underwent all-arthroscopic ATFL repair, and Group Z (n=8) underwent mini-open MBG repair. Both groups underwent supervised standardized rehabilitation programs under the same team of Sports Medicine Doctors & Sports Physiotherapists. Primary outcome measures included the American Orthopaedic Foot & Ankle Society (AOFAS) score, Visual Analog Scale (VAS) for pain, Time to Full Weight Bearing (FFWB), and Time to Return to Play (RTP) assessed over a 12-month follow-up period.

Results: Both groups demonstrated significant improvement in functional scores post-operatively. At the 12-month follow-up, there was no statistically significant difference in the final AOFAS scores between the two groups (p=0.21). However, the arthroscopic group (Group A) demonstrated significantly lower VAS pain scores at Week 2 (4.1 +/- 0.8, p<0.01) and a faster time to Full Weight Bearing (3.5 weeks, p=0.03). Additionally, a few athletes in the mini-open group (Group Z) presented with restricted range of motion during the initial rehabilitation period. While "RTP-Light" (return to non-contact training) was faster in the arthroscopic group (5.8 weeks), there was no significant difference in the time to full match RTP (p=0.18). Intra-articular pathologies were identified and treated concurrently in the arthroscopic group.

Conclusion: Both mini-open and all-arthroscopic ATFL repair techniques provide excellent functional outcomes for elite footballers. The all-arthroscopic technique offers distinct advantages of reduced early post-operative pain, earlier weight-bearing, and the ability to diagnose and treat concomitant intra-articular pathology. While long-term functional outcomes are comparable, thearthroscopic approach may offer "early wins" in rehabilitation milestones valuable for professional athletes.

Keywords: Chronic Lateral Ankle Instability, Anterior Talo-Fibular Ligament, Arthroscopic ATFL Repair