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Generalized Joint Laxity Is an Independent Predictor of Postoperative Resprain Following Anatomic Reconstruction
Haoxuan Liu1, Jianhong Li2, Tong Su1
1Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
Background:
Generalized joint laxity (GJL) has been reported as a risk factor for poor outcomes following multiligament surgery. However, no previous studies have investigated whether GJL is a risk factor of postoperative resprain following anatomic reconstruction using gracilis tendon autograft.
Purpose:
To investigate whether GJL is a risk factor of postoperative resprain in chronic lateral ankle instability (CLAI) patients following anatomic reconstruction using gracilis tendon autograft.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 290 consecutive CLAI patients who underwent anatomic reconstruction using gracilis tendon autograft from January 2018 to September 2023 with a minimum follow-up of 24 months were retrospectively evaluated and were divided into 2 groups according to the presence of GJL (based on age and Beighton score). Clinical outcomes were measured through the presence of postoperative noncontact resprain and recurrent instability, return-to-sport status, and patient-reported outcomes including the visual analog scale (VAS) for pain, Tegner Activity Level scale, and Karlsson-Peterson ankle score (Karlsson score). Risk factors associated with postoperative noncontact resprain were determined using univariate and multivariate logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis.
Results:
A total of 72 patients were included in the GJL group (mean age at surgery, 27.5 ± 9.0 years; male, n = 27; female, n = 45), and 218 patients were included in the non-GJL group (mean age at surgery, 32.8 ± 10.2 years; male, n = 129; female, n = 89). The overall noncontact resprain rate was 6.6%, and the overall recurrent instability rate was 1.7%. There was no significant difference in the postoperative VAS, Tegner, return to recreational sports rate, return to preinjury sports rate, and other surgical complications between the 2 groups. The patients with GJL demonstrated a significantly higher postoperative noncontact resprain rate (15.3% vs 3.7%; P = .001), a significantly higher postoperative recurrent instability rate (6.9% vs 0.0%; P = .001), and a significantly lower postoperative Karlsson score (90.0 ± 6.2 vs 95.6 ± 4.4; P < .001) compared with those without GJL. Multivariate logistic regression analysis revealed that GJL was an independent predictor of postoperative noncontact resprain following anatomic reconstruction using gracilis tendon autograft (P = .004; odds ratio = 4.293; 95% CI, 1.612-11.431). The cumulative success rates of the patients with GJL were significantly lower than those of the patients without GJL (P = .001).
Conclusion:
GJL is an independent predictor of postoperative noncontact resprain of CLAI patients following anatomic reconstruction using gracilis tendon autograft.
