{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:39:50Z","timestamp":1781188790548,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chungbuk National University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Despite a substantial duration of recovery following the modified Brostr\u00f6m procedure (MBP), many individuals do not entirely recover their preinjury sports performance. Return to sports (RTS) can be affected by multiple elements apart from a patient\u2019s motivation. This study aimed to investigate the factors influencing RTS after anatomical ligament repair for chronic ankle instability. Methods: Sixty-two patients aged under 35 who underwent the MBP were regularly monitored for up to 3 years. Of these, 51 patients (82.3%) returned to their preinjury level of sports activity (return group), while 11 patients (17.7%) complained of partial or significant limitations (non-return group). Clinical outcomes were measured by the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Mechanical stability was examined through physical examination and stress radiography. Peroneal strength was evaluated with an isokinetic dynamometer. Static and dynamic postural control abilities were tested using Biodex posturography. Results: Significant group differences were found in FAOS pain (94.7 points in the return group vs. 85.1 points in the non-return group; p = 0.004) and sports (91.2 vs. 78.8 points; p &lt; 0.001) subscales. In the FAAM, the sports activity subscale also showed significant disparities (90.5 vs. 77.4 points, p &lt; 0.001). Mechanical instability recurred in 2 patients (3.9%) in the return group and 4 patients (36.4%) in the non-return group, indicating a significant difference (p &lt; 0.001). No notable differences were identified in stress radiography values or peroneal strength measurements. Posturographic evaluation showed that static postural control ability (overall stability index) did not differ significantly between the groups (1.22 in the return group vs. 1.43 in the non-return group); however, dynamic postural control ability differed substantially (1.41 vs. 2.33, p = 0.002). Conclusions: Residual pain, recurrence of mechanical instability, and insufficient recovery of dynamic postural control ability were associated with the return to preinjury level of sports activity after the MBP. Comprehensive rehabilitation protocols should address these factors to facilitate optimal postoperative sports participation.<\/jats:p>","DOI":"10.3390\/jcm14176046","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:43:18Z","timestamp":1756219398000},"page":"6046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Return to Sports Following the Modified Brostr\u00f6m Procedure for Chronic Ankle Instability"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3338-1087","authenticated-orcid":false,"given":"Sung-Hoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1579-7898","authenticated-orcid":false,"given":"Seung-Myung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Daejeon Bon Hospital, Daejeon 34188, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-598X","authenticated-orcid":false,"given":"Byung-Ki","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1177\/107110070602701019","article-title":"Current concepts: Lateral ankle instability","volume":"27","author":"DiGiovanni","year":"2006","journal-title":"Foot Ankle Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1136\/bjsports-2011-090490","article-title":"Diagnosis, treatment and prevention of ankle sprains: An evidence based clinical guideline","volume":"46","author":"Vuurberg","year":"2012","journal-title":"Br. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/1938640014539813","article-title":"Lateral ankle sprain and chronic ankle instability: A critical review","volume":"7","author":"Kobayashi","year":"2014","journal-title":"Foot Ankle Spec."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.amjmed.2007.11.018","article-title":"What is the clinical course of acute ankle sprains? A systematic literature review","volume":"121","author":"Bernsen","year":"2008","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1177\/1071100718793395","article-title":"Outcome following a modified Brostr\u00f6m procedure and arthroscopic debridement of medial gutter osteoarthritis combined with chronic ankle instability","volume":"39","author":"Cho","year":"2018","journal-title":"Foot Ankle Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s00167-019-05582-4","article-title":"Modified Brostr\u00f6m procedure in patients with chronic ankle instability is superior to conservative treatment in terms of muscle endurance and postural stability","volume":"28","author":"Lee","year":"2020","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1177\/0363546512474967","article-title":"Isolated anterior talofibular ligament Brostr\u00f6m repair for chronic lateral ankle instability: 9-year follow-up","volume":"41","author":"Maffulli","year":"2013","journal-title":"Am. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1007\/s00167-015-3815-1","article-title":"Return to sport following acute lateral ligament repair of the ankle in professional athletes","volume":"24","author":"White","year":"2016","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1038\/s41598-021-04567-z","article-title":"Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Brostr\u00f6m procedure","volume":"12","author":"Lee","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.1007\/s00167-022-07270-2","article-title":"Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes","volume":"31","author":"Hong","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4055\/cios.2019.11.1.126","article-title":"Return to play after modified Brostr\u00f6m operation for chronic ankle instability in elite athletes","volume":"11","author":"Lee","year":"2019","journal-title":"Clin. Orthop. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1177\/03635465231170699","article-title":"Return to sport after anatomic lateral ankle stabilization surgery for chronic ankle instability: A systematic review and meta-analysis","volume":"52","author":"Li","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2325967119873852","DOI":"10.1177\/2325967119873852","article-title":"Clinical guidelines for the surgical management of chronic lateral ankle instability: A consensus reached by systematic review of the available data","volume":"7","author":"Song","year":"2019","journal-title":"Orthop. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/107110070102201004","article-title":"Validation of the foot and ankle outcome score for ankle ligament reconstruction","volume":"22","author":"Roos","year":"2001","journal-title":"Foot Ankle Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1177\/107110070502601113","article-title":"Evidence of validity for the foot and ankle ability measure (FAAM)","volume":"26","author":"Martin","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"600","DOI":"10.4085\/1062-6050-46.6.600","article-title":"Validity and reliability of limits-of-stability testing: A comparison of 2 postural stability evaluation devices","volume":"46","author":"Pickerill","year":"2011","journal-title":"J. Athl. Train."},{"key":"ref_17","first-page":"386","article-title":"Is there a link between chronic ankle instability and postural instability?","volume":"37","author":"Riemann","year":"2002","journal-title":"J. Athl. Train."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s43465-021-00532-0","article-title":"Outcomes and return to sports following the ankle lateral ligament reconstruction in profess sional athletes: A systematic review of the literature","volume":"56","author":"Goru","year":"2021","journal-title":"Indian J. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4003","DOI":"10.1007\/s00167-020-06020-6","article-title":"The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction","volume":"28","author":"Sigonney","year":"2020","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1136\/emj.20.6.508","article-title":"Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains","volume":"20","author":"Bridgman","year":"2003","journal-title":"Emerg. Med. J."},{"key":"ref_21","first-page":"CD000380","article-title":"Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults","volume":"2","author":"Kerkhoffs","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/0363546509346390","article-title":"Return to training and playing after posterior ankle arthroscopy for posterior impinge ment in elite professional soccer","volume":"38","author":"Calder","year":"2010","journal-title":"Am. J. Sports Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102227","DOI":"10.1016\/j.jcot.2023.102227","article-title":"Return to sports after ankle reconstruction with tendon grafts in chronic lateral ankle instability: A systematic review and meta-analysis","volume":"43","author":"Raja","year":"2023","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1682\/JRRD.2006.01.0001","article-title":"Balance problems after unilateral lateral ankle sprains","volume":"43","author":"Akbari","year":"2006","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.injury.2020.09.065","article-title":"Cross-education effect of balance training program in patients with chronic ankle instability: A randomized controlled trial","volume":"52","author":"Elsotohy","year":"2021","journal-title":"Injury"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4085\/1062-6050-43.3.293","article-title":"Systematic review of postural control and lateral ankle instability, part I: Can deficits be detected with instrumented testing?","volume":"43","author":"McKeon","year":"2008","journal-title":"J. Athl. Train."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103398","DOI":"10.1016\/j.otsr.2022.103398","article-title":"Return to sports: Rate and time after arthroscopic surgery for chronic lateral ankle instability","volume":"108","author":"Bouveau","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1053\/j.jfas.2014.09.008","article-title":"A ligament reattachment technique for high demand athletes with chronic ankle instability","volume":"54","author":"Cho","year":"2015","journal-title":"J. Foot Ankle Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3113\/FAI.2011.0153","article-title":"Long term results after modified Brostrom procedure without calcaneofibular ligament reconstruction","volume":"32","author":"Lee","year":"2011","journal-title":"Foot Ankle Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1177\/1071100720976071","article-title":"Traditional modified Brostr\u00f6m vs. suture tape ligament augmenta tion","volume":"42","author":"Kulwin","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"24730114211045978","DOI":"10.1177\/24730114211045978","article-title":"Suture tape augmentation in lateral ankle ligament surgery: Current concepts review","volume":"6","author":"Lan","year":"2021","journal-title":"Foot Ankle Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1177\/1071100717742363","article-title":"Functional results of open Brostrom ankle ligament repair augmented with a suture tape","volume":"39","author":"Coetzee","year":"2018","journal-title":"Foot Ankle Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"10225536221141477","DOI":"10.1177\/10225536221141477","article-title":"Anatomic anterior talofibular ligament repair augmented with suture-tape for chronic ankle instability with poor quality of remnant ligamentous tissue","volume":"30","author":"Kim","year":"2022","journal-title":"J. Orthop. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/10711007241291049","article-title":"Usefulness of suture-tape augmentation based on intraoperative ankle stress radiographs during anatomical ligament repair for chronic lateral ankle instability","volume":"46","author":"Cho","year":"2025","journal-title":"Foot Ankle Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e12077","DOI":"10.1002\/jeo2.12077","article-title":"Ankle ligament reconstruction-return to sport after injury scale and return to sports after ankle ligament reconstruction or repair-A systematic review","volume":"11","author":"Wang","year":"2024","journal-title":"J. Exp. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.1007\/s00167-022-06895-7","article-title":"The ALR-RSI score is a valid and reproducible scale to assess psychological readiness before returning to sport after modified Brostr\u00f6m-Gould procedure","volume":"30","author":"Pioger","year":"2022","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6046\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:22Z","timestamp":1760034802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":36,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176046"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176046","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]}}}