Does Early Weight Bearing After Anterior Talofibular Ligament (ATFL) Repair Actually Improve Outcomes?

by Vince Vacketta, DPM

A retrospective study published this month compared two techniques in 65 patients who underwent open ATFL repair. Thirty-four patients received an internal brace and began weight bearing (WB) immediately. The other 31 patients had a traditional repair and began WB in a cast two weeks after surgery.

By the numbers

Complications were significantly higher in the internal brace group:

• Five patients (14.7%) in the internal brace group developed an infection.

• One patient (2.9%) in that group had persistent instability, and one (2.9%) had implant malposition.

• In the traditional repair group, no patients developed an infection.

• One patient (3.2%) in that group had symptomatic knot irritation.

Is faster really better?

These findings raise a broader question about early WB:

• Have we lost the plot with early WB? 

• Is it truly supported by clinical outcomes, or is it simply easier to market to patients?

• Early WB may speed short-term recovery, but its long-term superiority remains unproven. 

• It also carries additional risk, so surgeons should critically evaluate whether faster rehabilitation makes enough of a difference to a patient’s outcome to justify that risk.