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Do Mid-term Outcomes of Lateral Ankle Stabilization Procedures Differ Between Military and Civilian Populations?
Chihua Lee1,2, Maximilian G McQuade1,2, Amy A Ostrofe1,2
1C. Lee, A. A. Ostrofe, A. H. Goldman, T. J. Douglas, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
Clinical Orthopaedics and Related Research
|September 23, 2020
Summary
Lateral ankle stabilization in military personnel yielded lower good-to-excellent outcomes (67%) compared to civilian populations. Neither fibular periosteum augmentation nor surgeon specialty significantly impacted results, suggesting a need for cautious patient counseling.
Area of Science:
- Orthopaedic Surgery
- Sports Medicine
- Military Health
Background:
- Ankle instability is prevalent, with civilian studies reporting high success rates for lateral ankle stabilization.
- Military servicemembers face unique ankle stressors due to terrain and operational demands, potentially impacting surgical outcomes.
- Limited data exists on lateral ankle stabilization outcomes in the military population, particularly regarding fibular periosteum augmentation.
Purpose of the Study:
- To evaluate patient-reported outcomes (Foot and Ankle Disability Index - FADI) after lateral ankle stabilization in active-duty military personnel.
- To determine if fibular periosteum augmentation improves outcomes compared to standard repair.
- To assess if outcomes differ based on surgeon specialty (orthopaedic surgeon vs. podiatrist).
Main Methods:
- Retrospective analysis of 502 lateral ankle stabilizations performed between 2007-2017 in active-duty military personnel.
- Follow-up at a minimum of 2 years (mean 7 years) to assess FADI scores and military capabilities.
- Comparison of outcomes between procedures with and without fibular periosteum augmentation, and between orthopaedic surgeons and podiatrists.
Main Results:
- Overall, 67% of patients achieved good-to-excellent FADI scores, significantly lower than civilian benchmarks.
- No significant difference in good-to-excellent outcomes was found between procedures with (68%) and without (65%) fibular periosteum augmentation.
- Outcomes did not differ significantly based on whether the procedure was performed by an orthopaedic surgeon (66%) or a podiatrist (71%).
Conclusions:
- Lateral ankle stabilization in military servicemembers yields lower patient-reported outcomes than in civilians.
- Fibular periosteum augmentation and surgeon specialty did not significantly influence outcomes in this military cohort.
- Surgeons should counsel military patients on the potential for poorer outcomes, including permanent restrictions or medical discharge.
