Impact of Resilience on Long Term Outcomes of Open Brostrom-Gould Repair

CATEGORY: Ankle; Midfoot/Forefoot INTRODUCTION/PURPOSE: The Brostrom-Gould procedure has become known as the gold standard operative procedure for lateral ankle ligament repair. However, little is known about the factors effecting the intermediate outcomes of the Brostrom- Gould repair as measured by new patient reported outcomes instruments and the impact of resilience on post-operative outcomes. This is the first study investigate the impact of resilience on the outcomes of lateral ligament repair. METHODS: A retrospective chart review was performed on 173 patients identified using CPT code 27698 who underwent open modified Brostrom Gould lateral ligament repair from Jan 2013 to June 2020. Patient demographics, comorbidities, athletic activities, post op complications as well as co-pathologies commonly seen in CAI were collected. PROMIS Pain Interference v1.1, Physical Function v1.2, and FAAM were collected. Brief Resilience Scale was used to quantify resilience. A linear regression model was constructed to evaluate the independent effect of resilience on each PROMIS and FAAM outcome instrument. Variables were included in the regression model based on an a-priori significance threshold of p<.05 in bivariate analysis. RESULTS: Resilience was found to have an independent effect on all PROMIS and FAAM measures when controlling for the effect of confounding variables. Resilience's effect on outcome measures was as follows: PROMIS physical function (Unstandardized β 8.2, 95% CI 3.9 to 12.6), PROMIS Pain Interference (Unstandardized β -4.8, 95% CI -7.9 to -1.7), FAAM Activity of Daily Living Subscale (Unstandardized β 16.6, 95% CI 8.7 to 24.6), and FAAM Sports Subscale (Unstandardized β 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcomes metrics including: PROMIS Physical Function (Unstandardized β 9.4, 95% CI 2.8 to 16.0), PROMIS Pain Interference (Unstandardized β -5.3, 95% CI - 10.0 to -.582), and FAAM Sports Subscale scores Interference (Unstandardized β 34.4, 95% CI 15.4 to 53.4). CONCLUSION: Resilience and patient participation in athletic activities are independent predictors of improved postoperative functional outcomes as measured by PROMIS and FAAM instruments at intermediate term follow-up. Resilient patients and athletes reported significantly higher physical function and less pain burden postoperatively. Furthermore, preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.