Identification of predictive factors influencing return to sport in patients following lateral ankle ligament surgery: A prospective cohort study

ObjectiveAnkle sprains, particularly lateral inversion injuries, commonly lead to chronic instability and often require surgical interventions; however, 25% of patients fail to return to sport (RTS) because of persistent physical or psychological barriers. This study aimed to identify demographic, surgical, rehabilitation, functional, and psychological factors influencing RTS in patients following lateral ankle ligament surgery.MethodsThis was a single-center prospective cohort study that included 132 patients (aged 28.23 ± 5.93 years) who underwent lateral ankle ligament surgery at the Fourth Medical Center of PLA General Hospital. The data included demographics, surgical type, rehabilitation information, functional outcomes and psychological readiness. Statistical analyses included univariate/multivariate logistic regression and receiver operating characteristic (ROC) curves to identify factors and optimal cutoffs for RTS.ResultsThe RTS rate was 52.27% (69/132), with a mean return time of 172 days. Compared with reconstruction, repair surgery demonstrated superior RTS rates (56.3% vs. 30.0%). The American Orthopedic Foot and Ankle Society (AOFAS) score73.5 (AUC = 0.92; sensitivity: 0.884, specificity: 0.587), visual analog scale (VAS) score≤3.5 (AUC = 0.78), and Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) score≥62.9 (AUC = 0.64) emerged as critical thresholds. Multivariate analysis revealed three independent predictors influencing RTS timing: surgical repair type (<i>p</i> = 0.005), psychological readiness (<i>p</i> < 0.001), and inpatient rehabilitation (<i>p</i> = 0.031).ConclusionsIn this study, successful RTS hinges on repair techniques, functional recovery (AOFAS score ≥ 73.5), pain reduction (VAS score ≤ 3.5), and psychological readiness (ALR-RSI score ≥ 62.9). Clinicians should prioritize individualized, milestone-driven programs to optimize outcomes and reduce delayed recovery.