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While many patients recover with conservative care, chronic ATFL tears can lead to persistent pain and instability, often requiring surgery and favoring minimally invasive approaches. Aim: Assess clinical outcomes of a novel totally percutaneous modified Broström repair (TP-MBR) in patients failing conservative treatment. Methods: Retrospective cohort of 20 patients treated between 2023 and 2024 with imaging, arthroscopy, and stress testing. Results: At 1.5 years, substantial improvements in American Orthopaedic Foot and Ankle Society and Karlsson scores, with resolution of instability, minimal tissue trauma, no major complications, and no recurrences.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/percutaneous-anterior-talofibular-ligament-repair-a-new-technique-for-chronic-ankle-instability/406792/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/percutaneous-anterior-talofibular-ligament-repair-a-new-technique-for-chronic-ankle-instability/406792.png","ImageObject",300,407,{"name":92,"@type":93},"Well Done","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition does the study target and why is it important?","Question",{"text":112,"@type":113},"The study targets chronic anterior talofibular ligament (ATFL) insufficiency causing persistent pain and ankle instability after conservative treatment. It is important because these cases often require surgical repair to restore stability.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the totally percutaneous modified Broström repair (TP-MBR) evaluated?",{"text":117,"@type":113},"A retrospective analysis of 20 patients treated with TP-MBR (between 2023 and 2024) assessed outcomes after confirmation by magnetic resonance imaging, arthroscopy, and stress testing, using American Orthopaedic Foot and Ankle Society and Karlsson scores at a mean follow-up of 1.5 years.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main outcomes and safety findings?",{"text":121,"@type":113},"All procedures were completed successfully with no intraoperative complications. At follow-up, functional scores improved significantly, all patients returned to pre-injury activity levels, and there were no recurrences or major complications.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406792,1790617870,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},5909892210082,"https://ap-avatar.wpscdn.com/avatar/56001069da27c9f41e8?x-image-process=image/resize,m_fixed,w_180,h_180&k=1789614185077863061","| W | J | O | World Journal of\u003Cbr>Orthopedics |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Orthop 2025 December 18; 16(12): 114166  \nDOI: 10.5312/wjo.v16.i12.114166 ISSN 2218-5836 (online)  \nORIGINAL ARTICLE  \nRetrospective Study  \nPercutaneous anterior talofibular ligament repair: A new technique for chronic ankle instability  \nMohamed M Elalfy, Osama M Embaby, Mahmoud M Mekkawy, Ameer A Sayed, Mohammed H Abushal  \nSpecialty type: Orthopedics  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade C  \nNovelty: Grade B  \nCreativity or Innovation: Grade C  \nScientific Significance: Grade C  \nP-Reviewer: Wang TL, MD, China  \nReceived: September 15, 2025  \nRevised: September 27, 2025  \nAccepted: October 28, 2025  \nPublished online: December 18, 2025  \nProcessing time: 95 Days and 7.8 Hours  \nMohamed M Elalfy, Department of Orthopedic Surgery, Mansoura University, Mansoura University Hospitals, Mansoura 35516, Egypt  \nMohamed M Elalfy, Department of Orthopedic Surgery, Andalusia Health, Jeddah 22341, Makkah al Mukarramah, Saudi Arabia  \nOsama M Embaby, Department of Orthopedic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B66 2QT, United Kingdom  \nOsama M Embaby, Department of Orthopedic Surgery, Damietta University, Damietta 34511, Egypt  \nMahmoud M Mekkawy, Department of Orthopedic Surgery, Andalusia Hospital, Jeddah 21433, Makkah al Mukarramah, Saudi Arabia  \nAmeer A Sayed, Department of Orthopedic Surgery, King Fahad Armed Forces Hospital, Ministry of Defense, Jeddah 23311, Saudi Arabia  \nMohammed H Abushal, Department of Orthopedic Surgery, University of Tabuk, Tabuk 71491, Saudi Arabia  \nCorresponding author: Mohamed M Elalfy, MD, Foot and ankle surgery consultant, Department of Orthopedic Surgery, Mansoura University, Mansoura University Hospitals, El-Gomhoria Street, Mansoura 35516, [Egypt.](Egypt. drmelalfy@mans.edu.eg)[ drmelalfy@mans.edu.eg](Egypt. drmelalfy@mans.edu.eg)  \nAbstract  \nBACKGROUND  \nThe 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.  \nAIM  \nTo 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.  \n WJO  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 18, 2025  Volume 16  Issue 12   \nElalfy MM et al. Percutaneous ATFL repair case series  \nMETHODS  \nThis 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.  \nRESULTS  \nAll 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 \u003C 0.001) and Karlsson scores (from 43.8 to 87.4; P \u003C 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.  \nCO","cbCaihR4o4yBzWdc","https://ap.wps.com/l/cbCaihR4o4yBzWdc","pdf",6701197,"English","# Abstract\n## Background\n## Aim\n## Methods\n## Results\n## Conclusion\n# Key Words\n# Core Tip\n# Citation","[{\"question\":\"What condition does the study target and why is it important?\",\"answer\":\"The study targets chronic anterior talofibular ligament (ATFL) insufficiency causing persistent pain and ankle instability after conservative treatment. It is important because these cases often require surgical repair to restore stability.\"},{\"question\":\"How was the totally percutaneous modified Broström repair (TP-MBR) evaluated?\",\"answer\":\"A retrospective analysis of 20 patients treated with TP-MBR (between 2023 and 2024) assessed outcomes after confirmation by magnetic resonance imaging, arthroscopy, and stress testing, using American Orthopaedic Foot and Ankle Society and Karlsson scores at a mean follow-up of 1.5 years.\"},{\"question\":\"What were the main outcomes and safety findings?\",\"answer\":\"All procedures were completed successfully with no intraoperative complications. At follow-up, functional scores improved significantly, all patients returned to pre-injury activity levels, and there were no recurrences or major complications.\"}]","Percutaneous anterior talofibular ligament repair - A new technique for chronic ankle instability | PDF",1790567860,23]