UNASSIGNED: To systematically review existing literature regarding the ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale and to assess its correlation with Return to sport and functional outcomes as well as feasibility, reliability and consistency.
UNASSIGNED: A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was conducted using PubMed, Embase and Cochrane Library. Studies that evaluated psychological readiness to return to sport after ankle ligament reconstruction or repair for the treatment of chronic lateral ankle instability using the ALR-RSI scale were included. The results from each study were pooled, and weighted means and overall rates were calculated.
UNASSIGNED: In total, 157 patients (53.2% male, mean age: 34.2 years) from three articles were included. Overall, 85.0% of patients reported successful return to sport, but only 48.9% of patients returned to the preoperative sporting level. All studies reported a significant difference in psychological scores between patients who returned to sport and those who did not. Pooled mean patient-reported outcome measures, reported as the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS, three studies) Score and Karlsson-Peterson Score (three studies), were 82.7 (range: 29-100) and 81.7 (range: 25-100), respectively. The ALR-RSI scale demonstrated strong correlations with the AOFAS Score and Karlsson-Peterson Score.
UNASSIGNED: Patients who returned to sport after ankle ligament reconstruction or repair exhibited higher psychological readiness compared to those who did not. The ALR-RSI scale showed strong correlations with ankle function. Evaluation of psychological readiness using the ALR-RSI scale may provide an additional tool in the assessment of patients who underwent ankle ligament reconstruction or repair.
UNASSIGNED: Level III, systematic review.

OBJECTIVE: To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft.
METHODS: Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed.
RESULTS: Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed.
CONCLUSIONS: Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients\' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory.
METHODS: IV.

OBJECTIVE: To introduce a novel transverse tunnel (TT) in anterior talofibular ligament (ATFL) reconstruction, and assess whether it was superior to the tunnels currently used.
METHODS: Thirteen fresh cadaveric lower extremities were perfused with lead-based contrast. Talar tunnels were drilled from the ATFL insertion in the following directions: transversely towards the medial side (TT), towards the talar neck (TNT), and towards the anterior, distal, and posterior points of the medial malleolus (AMMT, DMMT, and PMMT, respectively). MicroCT was used to reconstruct the tali, and virtual transosseous and 20-mm blind-ended tunnels were generated. The graft bending angle, vascular compromise caused by the tunnels, and the minimum distances from the tunnels to the chondral surfaces were evaluated.
RESULTS: The bending angles between the ATFL and the TT, TNT, AMMT, DMMT, and PMMT were 47.3±7.9°, 41.5±7.7°, 57.0±6.0°, 63.9±11.7°, and 87.9±6.2°, respectively. The proportion of damaged intraosseous vessels was significantly less for the TT (7.8±2.7%) compared with the AMMT (10.0±5.2%), DMMT (15.5±6.5%), and PMMT (16.9±3.9%). Both the TNT and the AMMT carried a high risk of joint penetration, with respective minimum distances of 2.2±1.7 mm and 1.4±1.0 mm from the tunnel to the cartilage; in contrast, the TT, DMMT, and PMMT had larger safety margins, with minimum distances of 5.4±0.8 mm, 8.9+2.7 mm, and 6.0±1.2 mm. The blind-ended tunnels caused less vascular compromise and had larger minimum distances to the cartilage (better drilling safety) than the transosseous tunnels for all tunnel directions.
CONCLUSIONS: The TT achieves a superior graft bending angle and intraosseous blood supply protection than the AMMT, DMMT, and PMMT, and is less likely to result in cartilage damage than the TNT. The 20-mm blind-ended tunnels achieve less vessel damage and better drilling safety than transosseous tunnels.

Background This case series evaluated the clinical and functional outcomes of patients with lateral ankle instability treated with a primary modified Brostrom-Evans.Methods Nineteen patients who underwent the modified Brostrom-Evans procedure for lateral ankle instability with a minimum follow-up of 5 years were reviewed. Physical exams were performed and weight-bearing ankle radiographs taken at final follow-up. Clinical outcomes were evaluated using Short Form Health Survey (SF-36), Foot Function Index (FFI), and Visual Analog Scale (VAS) scores. Functional outcomes were assessed using a goniometer for ankle range of motion (ROM) and dynamometer for ankle strength compared to the non-operative extremity.Results Average age at time of surgery was 34 ± 11 years (range 17-58 years) and average follow-up was 8.7 ± 2.8 years (range 5.1-15.4 years). At final follow-up, average total SF-36 and FFI scores were 83 ± 18 and 11% ± 18%, respectively. Average VAS at rest was 1 ± 1 and during activities 2 ± 2. There were no significant differences in ankle eversion ROM or strength between operative and non-operative extremities. Ankle eversion strength in operative extremities was 91 ± 12% of non-operative ankles. Ankle ROM was similar in all planes except for a 41% decrease in ankle inversion in surgically treated extremities compared to the contralateral side (p = .01).Conclusions Patients treated with the modified Brostrom-Evans procedure for lateral ankle ligament reconstruction have minimal loss of peroneal strength, decreased inversion ROM, and no recurrent instability or progressive symptomatic subtalar arthritis requiring re-operation at long-term follow-up.
METHODS: Level IV: Retrospective case series.

Chronic ankle instability secondary to lateral ligament insufficiency is common after sports injury. Many surgical techniques have been described for the treatment of the lateral ankle ligament complex. They can be classified into repair or reconstruction, and non-anatomical or anatomical. A few authors have recently published innovative techniques for arthroscopic ankle ligament management. This paper describes the arthroscopic techniques enabling anatomical lateral ligament reconstruction using gracilis autograft or allograft for chronic ankle instability. This technique and the steps have been developed by the Ankle Instability Group to make this a reproducible procedure. The purpose of this presentation is to document the technique in the future with a view to a clinical study investigating the results of such surgery in a cohort of suitable patients with chronic ankle instability.
METHODS: V.