Summary

The Ankle-GO™ is a valid score to evaluate and discriminate patients during the RTS continuum after and predict the RTS at the same level of play 9 months after surgery.

Abstract

Background

Ankle-GO™ is a composite outcome score, based on 4 functional tests and 2 Patient-Reported Outcomes Measurement System (PROMs). It was initially described and validated for its ability to predict return to sports at the same level of play after lateral ankle sprains
Purpose/Hypothesis: The main aim of this study was to assess the psychometric properties of the Ankle-GO™ in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict return to sport at the same level of play. The hypothesis is that Ankle-GO™ score is a valid and reliable score able to discriminate and predict the level of return to sports 9 months after an Achilles tendon repair.
Study design: This was a prospective case-control study (level of evidence: 3).

Methods

This was a prospective multicenter study. Patients who were sports active and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 subjects with no history of lower limb injury was also evaluated. After standard rehabilitation for the first two months, the Ankle-GO™ assessment was performed at 6- and 9-months following repair by the same experienced physical therapist. During each test, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between healthy subjects and those nine months post-surgery was performed.

Results

A total of 50 patients (24 women and 26 men), mean age 38.3 ± 10.1 years old were included. No patients were lost to follow up at 9 months. The Ankle-GO™ score at 6 months was found to be 10.7 ± 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum total score was 3 points (5 subjects, 10%). Only one patient (2%) obtained the maximum score (25 points). There was a significant difference among the Ankle-GO™ results in patients at 6 and 9 months and between control subjects and patients 9 month after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to the preinjury level of sport at 9 months. The capacity of Ankle-GO™ at 6 months to predict return to sports at preinjury level at 9 months was good (AUC = 0.71; 95% CI, 0.56-0.85; P < 0.01). A Youden index of 0.38 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.

Conclusions

The Ankle-GO™ is a valid score to evaluate and discriminate patients during the RTS continuum after and predict the RTS at the same level of play 9 months after surgery. This global score assesses ankle function and the patient’s psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of recurrence.