Ankle sprains, one of the most frequent accidental injuries in traumatology, can lead to chronic instability. Although arthroscopic anatomic ankle ligament reconstruction seems to provide good results, very few studies have specifically examined the outcomes of this procedure. The main goal of this study was to evaluate the rate of and delay to return to sport (RTS) at the preinjury level after anatomic ligament reconstruction and the predictive factors of a RTS in an athletic population. The secondary objectives were to report postoperative satisfaction and functional and psychological scores.

This retrospective multicenter study included 92 athletes who underwent ankle ligament reconstruction between 2015 and 2022 at three different centers with a minimum follow-up of one year. The primary outcome measurement was the percentage, quality and time to RTS. Secondary outcome measurements included the ALR-RSI, FAAM functional scores, satisfaction, and complications rates at the final follow-up. The effect of different variables (age, sex, preoperative level of play, circumstances of the first accident) on RTS was assessed.

Forty-six men (50%) and 46 women (50%), mean age 36.6 years old (SD = 12), were included. Mean follow-up was 37.5 (SD = 23.9) months. At the final follow-up, 85.9% patients had RTS. The analysis did not reveal any factors significantly associated with a RTS at the preinjury level of play except for a trend towards a higher percentage of RTS at the preinjury level in patients with a higher preoperative level of sports activity (p = 0.052). The mean ALR-RSI score at the final follow-up was 67.7% (SD = 24.1), the FAAM sport score was 79.9% (SD = 26.2) and the FAAM adl score was 89.6% (SD = 16.9). Nine patients had postoperative complications, usually discomfort on the endobutton, requiring removal.

This study shows that arthroscopic anatomic ankle ligament reconstruction is associated with high rate of RTS (85.9%) after a mean 7.5 (6.9) months as well as a high rate of satisfaction. Although this study did not identify any predictive factors for the RTS, the preoperative level of sports might play a role. In addition, this study once again confirms that functional and psychological scores are practical tools to assess a patient's postoperative readiness to RTS.

IV; retrospective study.