BACKGROUND: As a prevalent result of recurrent ankle sprains, chronic ankle instability (CAI) leads to persistent discomfort, impaired function, and mechanical instability. While ankle arthroscopic surgery effectively restores joint stability, its impact on psychological well-being remains uncertain. Patients with CAI frequently experience anxiety and depression, potentially influencing postoperative outcomes. The objective of this study was to examine improvements in anxiety and depression symptoms after arthroscopic anterior talofibular ligament (ATFL) repair and analyze the connection between preoperative mental health and surgical outcomes. METHODS: This retrospective cohort study included 60 patients who underwent arthroscopic ATFL repair for CAI. The Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) were utilized for psychological assessments preoperatively and postoperatively. The Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score were employed to evaluate pain levels and functional recovery. Based on preoperative psychological status, patients were divided into two groups: Group A, comprising those with anxiety or depression, and Group B, consisting of those without. The impact of preoperative mental health on postoperative outcomes was analyzed statistically. RESULTS: Out of the 60 enrolled patients, 56 completed follow-up assessments. Preoperative anxiety and depression were present in 38% of patients (Group A). Both groups exhibited notable postoperative improvements in SAS, SDS, AOFAS, and VAS scores postoperatively (p < 0.05). However, Group A exhibited a less favorable prognosis, with lower improvements in pain relief, functional recovery, and psychological well-being compared to Group B. A strong association between higher preoperative pain scores and increased anxiety was observed in the correlation analysis. In contrast, lower ankle function scores were linked to higher depression levels. Preoperative anxiety showed a strong correlation with disease duration, while older individuals exhibited higher levels of preoperative depression. CONCLUSION: Arthroscopic ATFL repair significantly improved psychological well-being, functional outcomes, and pain levels in CAI patients. Nevertheless, the adverse impact of preoperative anxiety and depression on recovery emphasized the importance of incorporating mental health evaluations and psychological support into treatment strategies. Optimizing postoperative recovery in CAI patients requires a holistic, interdisciplinary strategy that incorporates both physical and psychological considerations.