Long-Term Clinical and Patient-Reported Outcomes Following the Brostrom-Gould Procedure

Abstract

Category: Ankle; Sports; Trauma Introduction/Purpose: Chronic ankle instability (CAI) is a commonly encountered condition amongst foot and ankle surgeons and is characterized by loss of function and stability of the ankle following multiple or poorly healed ankle sprains. The Brostrom- Gould procedure is a widely accepted method of addressing CAI and has been seen to produce favorable outcomes in terms of regaining ankle function and stability. While long-term clinical results of the Brostrom-Gould procedure exist in the literature, there is little published on long-term patient-reported outcomes. Methods: Patients that underwent the Brostrom-Gould procedure from 2011 to 2015 were identified. The electronic medical record was utilized to collect patient demographics, preoperative and postoperative diagnosis, and clinical outcomes. Patients were then surveyed to obtain PROMIS domain scores (physical function, pain interference, and depression), resiliency scores, foot and ankle ability measure (FAAM) scores, pain level, and ability to return to work postoperatively. Criteria for inclusion in our study was the successful collection of survey data. Results: 50 patients were successfully surveyed for long-term postoperative patient-reported outcomes. Patients were surveyed at least 5 years after their original date of surgery with a median time of 6.7 (IQR 1.89) years. Four patients experienced complications including wound complications, sural nerve injury, and reflex sympathetic dystrophy. Four individuals had recurrence of instability with a median of 11.3 months (IQR 8.8) and six patients underwent reoperations. There was significant association of prior ankle instability surgery with PROMIS physical function scores (p=0.013) and being an athlete with PROMIS pain interference scores (p=0.042). Increased age was correlated with lower PROMIS functional scores (p=0.047) and lower FAAM ADL scores (p=0.044). Longer time to survey was significantly associated with an increased FAAM sports score (p=0.048). Longer time to survey was non-significantly associated with increased PROMIS functional scores (p=0.17), decreased PROMIS pain interference scores (p=0.52), and increased FAAM ADL scores (p=0.45). Conclusion: Patient-reported outcomes are important to measure to gain insight into the patient experience following the procedure and may be helpful in preoperative counseling. Our preliminary results suggest that longer time to follow up is associated with more favorable PROMIS domain and FAAM scores. We intend to conduct more surveys to add more power to our study.