Triage Assessment of Lateral Ankle Sprain Surgical Risk (TALAR Score): Using Early Red Flags to Predict the Failure of Conservative Management

Background: Functional testing after an ankle sprain may help identify patients who later develop mechanical instability and require surgery. This study aimed to identify early clinical and functional predictors of surgical stabilization for chronic ankle instability (CAI) after acute sprains and to develop a simple composite predictive score (TALAR). Methods: This prospective observational study included 197 patients with acute lateral ankle sprains. Comprehensive clinical and functional assessments, including range of motion (ROM), strength, and pain, were performed two weeks post-injury. The primary outcome was subsequent surgical management for instability within a 24-month follow-up period. Results: Eight patients (4%) ultimately underwent surgical stabilization. Univariable analysis identified three significant predictors of surgical outcome: eversion mobility ≥ 20°, plantar flexor strength ≤ 17 kg, and the presence of pain during dorsiflexion (VAS > 0). These variables were integrated into the 0–3 TALAR (Triage Assessment of Lateral Ankle sprain Surgical Risk) score, which demonstrated promising exploratory discrimination with an AUC of 0.889 (95% CI: 0.799–0.954). An optimal cut-off of ≥2 yielded a sensitivity of 0.875 and a specificity of 0.822. While the baseline surgical risk was 4%, patients with a TALAR score ≥2 had a 17.5% conversion rate to surgery, representing a significantly higher risk (OR: 32.24; p < 0.001). Conclusion: The TALAR score represents a promising exploratory tool for early risk stratification after an acute ankle sprain. As an exploratory study, it highlights that early functional red flags, though formal internal and external validation, along with robust calibration on longer follow-up cohorts, are required before clinical implementation.