The ALR-RSI score is a valid and reproducible scale to assess psychological readiness before returning to sport after modified Broström-Gould procedure.

PURPOSE: Psychological readiness scores have been developed to optimize the return to play in many sports-related injuries. The purpose of this study was to statistically validate the ankle ligament reconstruction-return to sport injury (ALR-RSI) scale after modified Broström-Gould (MBG) procedure. METHODS: A similar version of the ACL-RSI scale with 12 items was adapted to quantify the psychological readiness to RTS after MBG and to describe construct validity, discriminant validity, feasibility, reliability and internal consistency of the scale, according to the COSMIN methodology. The term "knee" was replaced by "ankle". The AOFAS and Karlsson scores were used as references patient-related outcome measurements (PROMs). RESULTS: A total of 71 patients were included. The ALR-RSI score after MBG procedure was highly (r > 0.5) correlated to the AOFAS and Karlsson scores, with a Pearson coefficient r = 0.69 [0.54-0.80] and 0.72 [0.53-0.82], respectively. The mean ALR-RSI score was significantly greater in the subgroup of 55 patients who resumed sports activity compared to those that no longer practiced sport: 61.9 (43.8-79.6) vs 43.4 (25.0-55.6), (p = 0.01). The test-retest showed an "excellent" reproducibility with a ρ intraclass correlation coefficient of 0.93 [0.86-0.96]. The Cronbach's alpha statistic was 0.95, attesting an "excellent" internal consistency between the 12 ALR-RSI items. CONCLUSION: The ALR-RSI score is a valid and reproducible tool for the assessment of psychological readiness to RTS after an MBG procedure for the management of CLAI, in a young and active population. The ALR-RSI score may help to identify and counsel athletes on their ability to return to sport. LEVEL OF EVIDENCE: III.

Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table.

INTRODUCTION: Primary total hip replacement (THR) comes with a risk of leg length discrepancy (LLD), which occurs in 25 % of cases, especially when the surgery is done using an anterior approach on a traction table, since it is not easy to verify the lengths of the legs. By doing the anterior approach on a standard table an intraoperative visual evaluation of leg lengths can be done after the trial implants are in place. As far as we know, the ability to set the leg length has not been compared between procedures done on a standard table or a traction table. This led us to carry out a retrospective comparative study to determine whether using a standard table for anterior THR will 1) allow better control over leg length, 2) increase the risk of incorrect implant positioning, 3) increase the surgical complication rate. HYPOTHESIS: Anterior THR on a standard table will allow better control over leg length than anterior THR on a traction table. MATERIAL AND METHODS: This single center retrospective study included 266 THRs done between January 1, 2018 and November 2, 2019 for primary (n=219) or secondary (n=47) hip osteoarthritis. The 137 cases done with a traction table were compared to the 129 cases with a standard table. The two groups were comparable in terms of age, sex, body mass index, indication and bilateral implants. They were not comparable in the surgeon experience (more junior surgeons in the standard table group [p<0.001]) and types of implants used (more cementless cups and stems in the standard table group [p=0.001]). Radiographs were used to measure the LLD, cup inclination, and femoral stem placement in the frontal plane. Any early complications were documented. The target was for the operated leg to be the same length as the contralateral leg, which was defined as within 10mm of each other. RESULTS: The mean postoperative LLD was comparable between the traction table group 1.56±7.32 mm (min -15.6 max 17.2) and the standard table group 0.53±6.93 mm (min -16.4 max 13.7) (p=0.24). In the traction table group, 81 % (111/137) of patients had legs of the same length, versus 84 % (109/129) in the standard table group (p=0.7). Cup inclination was comparable with a mean of 40.4±7.1 degrees (min 23.4; max 58.5) in the traction table group versus 39.3±7.5 degrees (min 19.9; max 60.9) in the standard table group (p=0.21). The frontal position of the femoral stem was comparable between groups with a mean of 0.09±0.45 degrees (min -1; max 3.98) in the traction table group versus 0.08±0.59 degrees (min -4.97; max 1.93) in the standard table group (p=0.86). There were 5 complications (3.7 %) in the traction table group versus 11 (8.5 %) in the standard table group (p=0.16). CONCLUSION: Use of a standard table to carry out THR by the direct anterior approach does not provide better control over leg length than using a traction table, subject to preoperative planning. When doing the procedure on a standard table, the implant placement is at least comparable, with a similar risk of complications. LEVEL OF EVIDENCE: III; case matched study.

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.

PURPOSE: Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. METHODS: The form was designed like the anterior cruciate ligament-return to sport after injury scale and "Knee" was replaced by the term "ankle". The ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale was filled by patients who underwent ankle ligament reconstruction and were active in sports. The scale was then validated according to the international COSMIN methodology. The AOFAS and Karlsson scores were used as reference questionnaires. RESULTS: Fifty-seven patients (59 ankles) were included, 27 women. The ALR-RSI scale was strongly correlated with the Karlsson score (r = 0.79 [0.66-0.87]) and the AOFAS score (r = 0.8 [0.66-0.87]). A highly significant difference was found in the ALR-RSI between the subgroup of 50 patients who returned to playing sport and the seven who did not: 68.8 (56.5-86.5) vs 45.0 (31.3-55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.92; 95% CI [0.86-0.96]). CONCLUSION: The ALR-RSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after ankle ligament reconstruction. This scale may help to identify athletes who will find sport resumption difficult. LEVEL OF EVIDENCE: III.