From the Department of Orthopaedic Surgery, University of Alabama at Birmingham; Birmingham, AL.
J Am Acad Orthop Surg Glob Res Rev. 2021 Nov 18;5(11):e21.00103. doi: 10.5435/JAAOSGlobal-D-21-00103.
INTRODUCTION: Little is known about the factors affecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcome instruments and the impact of patient resilience on postoperative outcomes. This is the first study to investigate the impact of resilience on the outcomes of lateral ligament repair. METHODS: Retrospectively, 173 patients undergoing Brostrom-Gould at single institution from January 2013 to June 2020 were identified. Patient characteristics, participation in athletic activities, surgical variables, and complications were recorded. Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference v1.1 (PI), Physical Function v1.2 (PF), and the Foot Ankle Ability Measure (FAAM) were collected. The 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 <0.05 in bivariate analysis. RESULTS: Resilience's independent effect on outcome measures was as follows: PROMIS PF (unstandardized β 8.2, 95% confidence interval [CI] 3.9 to 12.6), PROMIS PI (unstandardized β -4.8, 95% CI -7.9 to -1.7), FAAM Activities of Daily Living (unstandardized β 16.6, 95% CI 8.7 to 24.6), and FAAM Sports (unstandardized β 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcome metrics including PROMIS PF (unstandardized β 9.4, 95% CI 2.8 to 16.0), PROMIS PI (unstandardized β -5.3, 95% CI -10.0 to -0.582), and FAAM Sport scores (unstandardized β 34.4, 95% CI 15.4 to 53.4). CONCLUSIONS: 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 markedly higher PF and less pain burden postoperatively. Preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.
简介：采用新的患者报告结局（PRO）量表评估的 Brostrom-Gould 修复的中间结局受哪些因素影响，以及患者韧性对术后结局的影响，目前知之甚少。这是第一项研究韧性对侧副韧带修复结局影响的研究。
方法：回顾性分析 2013 年 1 月至 2020 年 6 月于单中心行 Brostrom-Gould 手术的 173 例患者，记录患者特征、运动参与情况、手术变量和并发症。收集患者报告结局测量信息系统（PROMIS）疼痛干扰量表 v1.1（PI）、物理功能量表 v1.2（PF）和足踝能力量表（FAAM）。采用简明韧性量表（Brief Resilience Scale）量化韧性。建立线性回归模型，评估韧性对每个 PROMIS 和 FAAM 结局量表的独立影响。根据双变量分析中 P<0.05 的预设显著性阈值，将变量纳入回归模型。
结果：韧性对结局测量的独立影响如下：PROMIS PF（标准化β 8.2，95%置信区间[CI]3.9 至 12.6）、PROMIS PI（标准化β-4.8，95%CI-7.9 至-1.7）、FAAM 日常活动（标准化β 16.6，95%CI 8.7 至 24.6）和 FAAM 运动（标准化β 28.4，95%CI 15.9 至 40.9）。术前运动参与也对多个结局指标有积极的独立影响，包括 PROMIS PF（标准化β 9.4，95%CI 2.8 至 16.0）、PROMIS PI（标准化β-5.3，95%CI-10.0 至-0.582）和 FAAM 运动评分（标准化β 34.4，95%CI 15.4 至 53.4）。
结论：在中期随访中，韧性和患者参与运动是 PROMIS 和 FAAM 量表评估的术后功能结局改善的独立预测因素。有韧性的患者和运动员术后报告的 PF 更高，疼痛负担更小。术前对韧性的量化可以改善对踝关节侧副韧带修复患者的预后预测。
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