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Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The literature on elite athletes’ ability to return to sports (RTS) after early lateral ligament repair of the ankle remains inadequate. The time needed to RTS after modified Broström repair for acute grade III lateral ligament injuries in a large cohort of elite athletes was evaluated while assessing the impact of other associated injuries.

Methods

Prospective data from 147 elite athletes who underwent a primary lateral ligament repair for acute grade III injuries with clinical ankle instability from 2015 to 2019 with a minimum of 2-year follow-up were reviewed. Pertinent details such as characteristics of injury, time taken to RTS, impact of associated injuries on RTS and complications were recorded and analysed.

Results

The average age was 24.4 years (S.D = 4.9) with 89.1% males. Approximately two-thirds of the elite athletes were football players (66.0%) and 21.1% were rugby players. Isolated lateral ligament complex injuries were sustained by 122 (83%) patients, while 25 (17%) had associated injuries (osteochondral lesions of the talus/deltoid injury/syndesmosis injury). All 147 athletes returned to their preinjury level of sports with a median time of 69 days (range 58–132 days). There was no significant difference found in time to RTS between gender, age, and types of sports. However, there was a statistically significant difference noted in the time taken to RTS earlier in patients with isolated lateral ligament injuries when compared to those with associated injuries (68.6 vs. 82.8 days; p = 0.004). Multiple conditional linear regression yielded three independent predictors of longer time taken to RTS which were associated deltoid injury (7.5 days longer; 95% CI 2.9–12.3; p = 0.002), associated syndesmosis injury (6.7 days longer; 95% CI 0.5–12.8; p = 0.034) and associated OLT (30.3 days longer; 95% CI 25.1–35.5; p = 0.000).

Conclusion

Early surgical repair for acute grade III lateral ligament injuries in elite athletes yielded excellent rate of RTS at 9–10 weeks and a re-injury rate of 2%. Concomitant injuries will delay RTS after surgical intervention. These findings serve as important guide to managing elite athletes following acute rupture of the lateral ligament complex.

Level of evidence

Level III.

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Data availability

Authors can confirm that all relevant data are included in the article and/or its supplementary information files.

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Acknowledgements

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Funding

There is no funding for this study.

Author information

Authors and Affiliations

  1. Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK

    Choon Chiet Hong & James Calder

  2. Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK

    James Calder

  3. Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Choon Chiet Hong

Authors
  1. Choon Chiet Hong
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Contributions

Both authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CCH and JC. The first draft of the manuscript was written by CCH, and JC commented on previous versions of the manuscript. JC supervised and reviewed the final manuscript. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Choon Chiet Hong.

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Conflict of interest

Choon Chiet Hong has no conflict of interest. James Calder received remuneration for speaking in educational programme by Arthrex unrelated to this study.

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Institutional approval to undertake this study was provided in line with the UK Health Research Authority guidance with a waiver of consent.

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Hong, C.C., Calder, J. Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes. Knee Surg Sports Traumatol Arthrosc 31, 4519–4525 (2023). https://doi.org/10.1007/s00167-022-07270-2

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  • DOI: https://doi.org/10.1007/s00167-022-07270-2

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