Abstract
BackgroundAnkle sprain lesions are the most common ligament lesions in humans. One particularly dangerous consequence of this pathology is an inability to quickly and sufficiently depress the brake pedal when driving a car. The high incidence of the lesion, in the context of a society that is highly automobile-dependent, makes the question “When can a patient safely drive a car again?” of particular socioeconomic importance. Hypothesis/PurposeThough orthopaedic physicians are often confronted with this question, finding an answer in the sparse literature on the topic proves difficult. This study aims to provide a definitive answer to this question. Study DesignProspective Case Control Study. Methods30 patients with grad II and III ligament injuries of the right ankle (18 women, 12 men) and 30 healthy volunteers (19 women, 11 men) participated in this study. Brake reaction time (BRT) was assessed using a previously reported custom-made driving simulator. BRT was assessed two, four and six weeks after injury. Simultaneously the American Orthopedic Foot and Ankle Society Ankle Hindfoot Score (AOFAS-AHS) was assessed. ResultsTwo weeks after the incident, the patients’ BRT measured 690.6±186.2ms. Four weeks after the incident, the BRT improved to 551.8±137.3ms (p<0.001). Compared to the healthy controls’ BRT (553.6±118.6ms), there were no significant differences 4 weeks after the injury (p=0.473). At this time, the BRT of both groups was also well below (i.e. faster) than the recommendations of road authorities (700-1500ms). An AOFAS-AHS score of more than 80 points correlated with a sufficient BRT. ConclusionsFour weeks post injury, patients generally had a sufficient BRT to drive in traffic safely. Some patients could achieve sufficient BRTs at an earlier stage. All patients with sufficient BRTs had an AOFAS-AHS score of ≥81 points. The AOFAS-AHS score can therefore be regarded as an adequate screening tool to evaluate which patients are ready to safely operate motor vehicles earlier.
Highlights
Ankle sprain injuries are one of the most common traumas in modern medicine
Four weeks after the incident, the Brake reaction time (BRT) improved to 551.8±137.3ms (p
Compared to the healthy controls’ BRT (535.6±118.6ms), the patients’ BRT was significantly slower at two weeks (p=0.003) but not different at four weeks (p=0.473) (Cross-sectional comparison, Hypothesis 2, Table 2). At this point in time, the BRT was well below what was recommended by road authorities (700-1500ms) [17,18,19,20,21]
Summary
In the average United States (US) population, ankle sprain injuries are said to occur in 2.5 patients per 1000 person-years, with a substantial increase in young athletic patients (7.2 per 1000 person-year) [1] These estimations are based on database calculations [2], which only record patients presenting to emergency rooms and not those presenting in other ambulatory settings. Accounting for the fact that approximately only one-third of the patients with sprained ankles enter an emergency room, the incidence can be estimated to be between 5 and 7 per 1000 person-years [3]. Conclusions: Four weeks post injury, patients generally had a sufficient BRT to drive in traffic safely. The AOFAS-AHS score can be regarded as an adequate screening tool to evaluate which patients are ready to safely operate motor vehicles earlier
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