Increasing age is associated with worse sports function but not daily living function following arthroscopic anterior talofibular ligament repair.

BACKGROUND

Arthroscopic anterior talofibular ligament repair (AATFLR) has been shown to restore ankle function effectively and to provide favourable clinical outcomes in chronic lateral ankle instability (CLAI). The present study was designed to identify variables associated with suboptimal postoperative sports-related functional recovery in patients with CLAI.

METHODS

Patients who underwent AATFLR between December 2021 and February 2024 were included. Baseline characteristics including age, sex, body mass index, serum uric acid, concomitant avulsion/free bone fragments and osteochondral lesion of the talus were collected. Postoperative outcomes were assessed using the Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL), the FAAM-Sport score, the Karlsson score, the numeric rating scale pain score, and the Tegner score. Multivariable linear regression and ordinal logistic regression analyses were performed to identify variables associated with postoperative functional recovery. Regression coefficients are reported as β.

RESULTS

A total of 197 patients were included, with a mean follow-up of 30.0 months. All functional outcomes improved significantly postoperatively (p < 0.001). Multivariate regression analyses demonstrated that increasing age was associated with lower postoperative FAAM-Sport score (β = - 0.51, 95% CI [- 0.78; -0.23], p < 0.001). However, no association was observed between age and the FAAM-ADL score (β = - 0.07, 95% CI [- 0.26; 0.12], p = 0.471). Increasing age significantly reduced odds of achieving higher postoperative Tegner activity levels (OR = 0.947, 95% CI [0.92-0.98], p = 0.002). Female sex was associated with lower postoperative Karlsson score (β = - 6.56, 95% CI [- 10.92; - 2.21], p = 0.003), which did not achieve the minimal clinically important difference. The overall complication rate was 31.0%, consisting predominantly of minor complications.

CONCLUSIONS

AATFLR significantly improved ankle function and reduced pain in patients with CLAI. Increasing age may be associated with poorer postoperative sports-related functional recovery after AATFLR. However, it may not affect activities of daily living. Sex may not be associated with postoperative functional recovery. Older patients with high athletic demands should be provided with more comprehensive preoperative risk counselling. Level of evidence Level III, retrospective cohort study.