Virtual reality-based balance training for motor function recovery after anterior talofibular ligament repair: a randomised controlled trial protocol

Introduction Ankle sprain is one of the most common sports injuries. Approximately 40% of patients with anterior talofibular ligament (ATFL) rupture develop chronic ankle instability, characterised by persistent balance dysfunction. Although virtual reality-based balance training has shown beneficial effects in non-surgical populations with chronic ankle instability, its efficacy in patients after ATFL repair remains unclear. This study aims to evaluate the effects of virtual reality-based balance training on motor function recovery in patients after ATFL repair. Methods and analysis This study is a prospective, single-centre, assessor-blinded, parallel-group randomised controlled trial. Sixty-eight patients after unilateral ATFL repair will be randomly assigned (1:1) to an experimental group (virtual reality-based balance training plus conventional rehabilitation) or a control group (conventional balance training plus conventional rehabilitation). Both groups will receive a 4 week intervention, three times per week, consisting of 30 min of conventional ankle rehabilitation plus 30 min of balance training. The primary outcome is the change in the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score. Secondary outcomes include ankle joint position sense, isokinetic muscle strength, static balance, dynamic balance and safety. Assessments are performed at baseline, postintervention (4 weeks after baseline) and follow-up (8 weeks after baseline). Outcome assessors will be blinded to group allocation. Data will be analysed on an intention-to-treat basis using linear mixed-effects models. Protocol version: 1.0, 3 November 2025. Ethics and dissemination The study protocol has been approved by the Institutional Review Board of the Second Affiliated Hospital of Xi’an Jiaotong University (approval no. 2026 Lun Shen 043, protocol version: 1.0, 3 November 2025). The study will be conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants. Regardless of the results, the findings will be submitted for publication in a peer-reviewed journal and presented at national and international academic conferences. Trial registration number ChiCTR2600125841.