Early functional recovery following accelerated rehabilitation after arthroscopic anterior talofibular ligament repair.

BACKGROUND: Postoperative rehabilitation following anterior talofibular ligament (ATFL) repair commonly incorporates an initial period of protection with progressive weight-bearing and range of motion. Accelerated rehabilitation may facilitate earlier functional recovery, but clinical evidence remains limited. METHODS: A retrospective cohort study was performed on consecutive patients who underwent arthroscopic ATFL repair for chronic lateral ankle instability at a tertiary institution between January 2024 and June 2025. All patients followed a standardised accelerated rehabilitation protocol that included immediate weight-bearing and supervised range-of-motion exercises after surgery. Outcomes assessed included Foot and Ankle Ability Measure (FAAM) scores, Visual Analogue Scale (VAS), time to return to jogging, return to pre-injury level of sport and documented postoperative complications. RESULTS: Twenty patients were included, with a mean follow-up of 11.1 ± 3.5 months. Median FAAM Activities of Daily Living scores improved from 76.2 (Q1-Q3, 67.0-83.0) preoperatively to 99.2 (95.9-100.0) at 6 months, while median FAAM Sports scores improved from 43.5 (32.2-63.4) to 94.7 (82.8-100.0) (both p < 0.001). Median VAS scores decreased from 5.0 (4.0-6.0) preoperatively to 0.0 (0.0-1.0) at 6 months (p < 0.001). The median time to return to jogging was 42 days. Seventeen patients participated in sport preoperatively, all of whom returned to their pre-injury level of sport (17/17, 100%) at a median of 8 weeks (Q1-Q3, 6-11 weeks). No recurrent instability, repair failure, wound complication, or reoperation was observed. CONCLUSION: Accelerated rehabilitation following isolated arthroscopic ATFL repair was associated with significant early functional improvement and return to pre-injury sporting level in all preoperatively active patients, with no repair failures or recurrent instability observed during short-term follow-up. LEVEL OF EVIDENCE: IV.