Contralateral Balance Training Improves Postural Control and Functional Recovery After Arthroscopic Anterior Talofibular Ligament Repair: A Prospective, Randomized, Single-Blind Trial.

BACKGROUND

Chronic ankle instability (CAI) affects approximately 40% of patients within 1 year after a first-time acute lateral ankle sprain. While arthroscopic anterior talofibular ligament (ATFL) repair is preferred when conservative treatment fails, early postoperative balance training is limited by weight-bearing restrictions. Cross-education, which transfers training benefits from one limb to the contralateral untrained limb, has demonstrated efficacy in improving postural control under conservative care; however, its postoperative utility remains poorly understood. This study investigates whether integrating contralateral balance training into standard rehabilitation enhances functional recovery after ATFL repair.

METHODS

This study was conducted at the Sports Medicine Center of West China Hospital, Sichuan University (Chengdu, China) between November 2024 and November 2025. Fifty-eight participants with unilateral CAI undergoing arthroscopic ATFL repair were randomized to an assisted rehabilitation group (ARG, n = 29) or conventional rehabilitation group (CRG, n = 29). Both groups received 6-week standard rehabilitation. The ARG additionally performed progressive contralateral limb balance training three times per week for 6 weeks. Primary and secondary outcomes included static balance (sway velocity), dynamic postural control (Star Excursion Balance Test [SEBT]), sensory integration (Sensory Organization Test [SOT]), and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Scale, Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL] subscale, Foot and Ankle Ability Measure-Sports [FAAM-Sport] subscale, and Tampa Scale for Kinesiophobia [TSK]).

RESULTS

Post-intervention, the ARG demonstrated significantly lower eyes-closed sway velocity (P = 0.016) and greater SEBT reach distances in anterior (P = 0.005) and posterolateral (P = 0.018) directions than the CRG. The ARG also achieved superior equilibrium scores during sensory conflict (SOT-3: P < 0.001; SOT-4: P = 0.023). Furthermore, the ARG reported significantly better functional scores than the CRG, including AOFAS and FAAM-ADL, while FAAM-Sport showed relative preservation compared with a significant decline in the CRG.

CONCLUSION

Compared with conventional rehabilitation alone, supplemental contralateral balance training resulted in statistically superior postural control under eyes-closed conditions and in selected dynamic balance directions. Improvements in sensory integration (SOT3, SOT4) were statistically significant but did not reach the respective condition-specific MCIDs. This approach appears safe and feasible during early-stage rehabilitation, with the primary effect being attenuation of early postoperative decline.