[Objective] To compare the clinical efficacy of percutaneous anterior talofibular ligament (ATFL) and calcaneofibular liga- ment (CFL) reconstruction versus arthroscopic ATFL repair for chronic lateral ankle instability. [Methods] A retrospective study was done on 35 patients who underwent surgical treatment for chronic lateral ankle instability in our hospital from October 2015 to July 2020. Accord- ing to doctor-patient communication, 19 patients were treated with percutaneous reconstruction of ATFL and CFL (the percutaneous group) , while the remaining 16 patients received arthroscopic repair of ATFL (the arthroscopic group) . The documents regarding to perioperative pe- riod, follow-up and stress radiographs were compared between the two groups. [Results] All the patients in both groups had operation per- formed successfully without serious complications such as neurovascular injury. The percutaneous group proved significantly inferior to the arthroscopic group in terms of operation time, incision length, intraoperative blood loss and hospital stay (P＜0.05) . All patients in both groups were followed up for more than 24 months, and the percutaneous group resumed full weight-bearing activity significantly later than the arthroscopic group (P＜0.05) . The VAS decreased significantly (P＜0.05) , while AOFAS and KAFS scores increased significantly over time in both groups (P＜0.05) , whereas the ankle dorsal extension – plantar flexion range of motion (ROM) remained unchanged (P＞0.05) . At any corresponding time points, there was no significant difference in the above items between the two groups (P＞0.05) . Radiographically, the talus inclination angle under varus stress and talus anterior displacement under anterior drawer stress significantly reduced in both groups at 12 and 24 months after operation compared with those preoperatively (P＜0.05) , while the Kellgren-Lawrence classification for os- teoarthritis remained unchanged (P＞0.05) . Although there was no significant difference in talus inclination and talus anterior displacement between the two groups before operation (P＞0.05) , the percutaneous group proved significantly superior to the arthroscopic group in talus in-clination and talus anterior displacement at 12 and 24 months postoperatively (P＜0.05) . However, there was no significant difference in Kell- gren-Lawrence classification of ankle osteoarthritis between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The arthroscopic repair of ATFL has advantages of less iatrogenic trauma and faster recovery, while the percutaneous reconstruction of ATFL and CFL regains better ankle stability, which is suitable for people with higher requirements of ankle function.