DOI: 10.1177/23259671261486661 ISSN: 2325-9671

Return to Sport and Risk Factors for Recurrence After Arthroscopic Anatomic Lateral Ankle Ligament Reconstruction

Mohamad K. Moussa, Pavel Bogdan, Eugénie Valentin, Alain Meyer, Nicolas Lefèvre, Antoine Gerometta, Frederic Khiami, Yoann Bohu, Olivier Grimaud, Alexandre Hardy
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Background:

Chronic lateral ankle instability (CLAI) often requires surgical stabilization when conservative management or primary repair fails. While arthroscopic anatomic reconstruction using tendon autograft is increasingly used, data on strict return-to-sport (RTS) metrics and risk factors for recurrence in high-demand populations remain limited.

Purpose:

To evaluate the rate and timing of RTS, functional outcomes, and factors associated with failure after arthroscopic anatomic lateral ankle ligament reconstruction using a gracilis autograft.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 101 patients undergoing arthroscopic anatomic reconstruction with gracilis autograft for CLAI were evaluated at a minimum follow-up of 2 years. The primary outcome was RTS, defined as the resumption of full athletic activity. Secondary outcomes included return to preinjury level, recurrence of instability, rerupture, and functional assessment using the Foot and Ankle Outcome and Foot and Ankle Ability Measure (FAAM) scores. Risk factors for failure to RTS and recurrence were analyzed using univariate regression and multivariate stepwise logistic regression.

Results:

The overall RTS rate was 71.1% at a median delay of 6 months (5-8.5 months). However, only 45.6% of patients returned to their specific preinjury level. Multivariable analysis identified elevated body mass index (BMI) ( P = .014) as an independent factor associated with failure to return to the preinjury level, while higher preoperative FAAM-Activities of Daily Living scores ( P = .002) were factors associated with success. Significant improvements were observed in all functional scores at the final follow-up ( P < .001). A confirmed recurrence of instability occurred in 11.9% of patients, comprising 9.9% (10/101) with ankle sprains and only 2% (2/101) with graft rupture. In univariate analysis, younger age ( P = .007) and participation in pivot-contact sports ( P = .040) were associated with recurrent instability. In multivariable analysis, younger age emerged as an independent factor associated with recurrent instability ( P = .040).

Conclusion:

Arthroscopic anatomic reconstruction provided significant functional improvement with a low graft rupture rate (2%). However, returning to the preinjury level proved challenging (45.6%), particularly for patients with lower preoperative function or elevated BMI. Younger age was identified as an independent risk factor for recurrent sprains.

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