Chronic ankle instability (CAI) is a common condition following ankle sprains, particularly in active and athletic populations. When conservative treatment fails, surgical management is required to restore stability and enable return to sport (RTS). Arthroscopic anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using autograft has shown good results. However, evidence regarding allograft use remains limited, especially in prospective studies. The aim of this study was to evaluate clinical and functional outcomes after fully arthroscopic anatomic reconstruction using fresh-frozen allograft, with a specific focus on RTS.

Arthroscopic anatomic reconstruction using allograft provides satisfactory functional outcomes and allows a high rate of return to sport.

This monocentric prospective study included patients who underwent arthroscopic ATFL and CFL reconstruction with allograft between July 2022 and December 2023. Indications included symptomatic CAI, failure of at least 6 months of conservative treatment, and MRI-confirmed ligament lesions. All procedures were performed by a single experienced surgeon using a standardized technique. The primary outcome was RTS. Secondary outcomes included functional scores (AOFAS, EFAS, SFAV, ALR-RSI, Tegner), pain (VAS), patient satisfaction, complications, and recurrence-free survival.

Seventy-five patients (mean age 33.8 years) were analyzed at a mean follow-up of 16.3 ± 3.8 months. RTS was achieved in 98.7% of patients at a mean time of 5.2 ± 2.3 months. Among patients active preoperatively, the RTS rate reached 100%, with 80% returning to an equal or higher level of sport. All functional scores improved significantly: AOFAS from 58.2 ± 16.5 to 95.0 ± 6.7, EFAS Sport from 4.24 ± 4.3 to 12.7 ± 4.2, and SFAV from 43.8 ± 18.5 to 85.3 ± 12.8 (all p   <  0.001). Pain decreased significantly (VAS 3.7 ± 2.5 to 0.7 ± 1.2, p   <  0.001). The ALR-RSI score improved from 32.6 ± 20.0 to 70.8 ± 19.6 ( p   <  0.001). Recurrence-free survival was 97.3% at 6 months and 91.8% at 12 months. Complications occurred in 14.6% of patients, mostly minor, with 8% requiring additional treatment. No graft rupture was observed.

This study demonstrates that arthroscopic anatomic reconstruction of the lateral ankle ligaments using allograft provides excellent functional outcomes and a high rate of return to sport, with a relatively short recovery time. These findings are consistent with previous studies and suggest that allograft may represent a valuable alternative to autograft, avoiding donor-site morbidity. However, the absence of a control group and the relatively short follow-up limit the strength of the conclusions.

Arthroscopic anatomic reconstruction of the ATFL and CFL using fresh-frozen allograft is a safe and effective technique for the management of CAI. It allows a rapid and high rate of return to sport and provides excellent functional outcomes. Further comparative studies with longer follow-up are needed.

IV; prospective case series.