Long-Term Functional Outcomes and Return to Sport Activities in a Nonathlete Population after the Brostrom-Gould Repair

Abstract

Category: Sports; Trauma Introduction/Purpose: Acute ankle ligamentar lesion is one of the most common injuries related to sports practice and daily activities. Excellent clinical results have been achieved with functional rehabilitation in up to 80% of the patients. However, 20% may develop chronic ankle instability (CAI) with continued pain and repeated sprains, requiring surgical treatment. The aim of this study was to present the long-term functional outcomes and return to sport activities in a group of nonathlete patients with CAI who underwent lateral ligament repair using the Brostrom-Gould technique (BGT). Methods: Medical charts of 89 patients who underwent the BGT were retrospectively reviewed. The average follow-up was 7.1 (3.1 - 13.4) years. The mean age was 31.2 (16 - 65) years. 62 (69.7%) patients were male and 27 (30.3%), female. Demographic and clinical data were collected from medical records. For clinical and functional analysis, the AOFAS hindfoot-ankle score was applied (preoperatively and at the last follow-up) and return to physical activities was assessed. Other variables regarding residual pain, associated lesions (osteochondral lesions of the talus, bony or soft tissue impingements, syndesmotic and peroneal tendon injuries), associated predisposing anatomical conditions (tarsal coalition, cavovarus feet, accessory navicular bone and os trigonum), postoperative range of motion and complications were evaluated as well. Pre- and postoperative AOFAS scores were compared using paired Mann-Whitney test. Linear regression was used to assess the association of the Δ-AOFAS and return to physical activities with the other variables analyzed. Results: Prior to surgery, mean AOFAS score was 64.3, and postoperatively, 97.27 (p<.001). Seventy-one patients (79.8%) returned to the same physical activity. Associated lesions and pre-existing conditions were also treated (Tables 1-2). Complications occurred in 3 patients: posterior tibial nerve neuritis, hematoma at the calcaneal osteotomy site, paresthesia at the superficial peroneal nerve. Fifty-six (62.92%) patients had no complaints, 18 (20.22%) presented residual instability, 1 (1.12%) had eventual pain and 14 (15.73%) had constant mild pain. Partially limited inversion was found in 7 (7.87%) patients. In linear regression, residual instability and pre-existing conditions were related to Δ-AOFAS (p=.012 and p=.036). The first was associated with lesser improvement and the second with greater (Figure 1). Pain and residual instability were related to change in physical activity modality (Table 3). Conclusion: The present study demonstrated that patients who underwent the BGT presented excellent long-term functional outcomes with improvements in the AOFAS score. Approximately 80% returned to their previous level of physical activities. Those who underwent correction of a pre-existing anatomical condition in addition to the BGT were the ones who obtained the greatest improvements in AOFAS score. Eventual pain and residual instability after surgery were associated with limitations in physical activity.