Purpose This study sought to confirm whether traditional open Brostrom-Gould repair and arthroscopic Brostrom-Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high-demand patients. Methods This retrospective case-cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level & GE; 6, who underwent Brostrom-Gould repair and were followed up for & GE; 2 years. Patients were divided into the arthroscopic Brostrom-Gould repair group (AS Group) and the open Brostrom-Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K-P) scores, and American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores were evaluated clinically. Results A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K-P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K-P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not differ between the groups (all n.s.). Conclusions Traditional open and arthroscopic Brostrom-Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Brostrom-Gould repair may represent a viable surgical alternative to open Brostrom-Gould repair in high-demand patients.
