Eighty patients with an anterior talofibular ligament (ATFL) injury requiring surgical repair were randomized to receive an arthroscopic surgical repair (n=40) or an open surgical repair (n=40). The outcomes of interest included operative time, intra-operative blood loss, post-operative recovery time, the American Orthopaedic Foot and Ankle Society Hindfoot (AOFASh) scale, the Jersey Shore Science Fair (JSSF) ankle-hindfoot scale, the Karlsson Ankle Functional Score (KAFS), anterior displacement and tilt angle of the talus, and the incidence of complications. Outcomes were assessed at 6 months, 1 year and 2 years post-operation. Results revealed statistically significantly shorter operative time, less intraoperative blood loss, and shorter recovery time in the arthroscopy group compared to the open surgery group (p<0.001 for both). Moreover, AOFAS, KAFS, and JSSF scores were statistically significantly in favour of the arthroscopy group at 6 months (p<0.05 for all), but were not statistically significantly different between the two groups at 1 and 2 years post-operation (p>0.05 for all). The anterior displacement of the talus and tilt angle of the talus were not statistically different between groups at any time point (p>0.05 for all). Furthermore, 2 cases of temporary numbness of the foot and ankle were observed both the arthroscopy group and open surgery group. Additionally, 1 case of tread reaction was observed in the arthroscopy group vs 2 cases in the open surgery group.