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Risk Factors for Failure of Conservative Treatment Requiring Surgical Intervention in Male Patients with First-Time Acute Lateral Ankle Sprains

Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Acute lateral ankle sprain (ALAS) is a common sports-related injury. Although most patients achieve satisfactory recovery following conservative treatment, a subset ultimately requires surgical intervention. Early identification of individuals at high risk of conservative treatment failure is therefore of substantial clinical importance. Purpose To identify independent predictors of conservative treatment failure requiring subsequent surgical intervention in young and middle-aged male patients with a first-time ALAS after 6 months of standardized nonoperative management. Study Design: Cohort study; Level of evidence, 2. Methods This retrospective cohort study included young and middle-aged male patients presenting with a first-time ALAS at our institution between January 2023 and December 2025. All patients underwent standardized conservative treatment based on the PEACE & LOVE principles for at least 12 weeks and completed a minimum follow-up of 12 months. Baseline demographic characteristics, clinical assessment parameters (including the 10-Meter Walk Test[10MWT], Visual Analog Scale [VAS], Pain Catastrophizing Scale [PCS], Hospital Anxiety and Depression Scale [HADS], and Foot and Ankle Ability Measure–Sports Subscale [FAAM-Sport]), as well as ankle magnetic resonance imaging (MRI) findings obtained within 2 weeks of injury (including talus bone marrow lesions [BMLs] and tibiotalar joint effusion), were collected. The primary outcome was conversion to surgical treatment due to failure of conservative management at 6 months after injury. Multivariable logistic regression analysis was performed to identify independent predictors, and receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the model. Results A total of 266 patients were included in the final analysis, with a mean age of 29.9 ± 6.7 years (range, 18–45 years). Among them, 90 (33.8%) underwent surgical intervention at 6 months due to failure of conservative treatment. Multivariate logistic regression analysis demonstrated that moderate tibiotalar joint effusion (OR = 4.14, 95% CI: 1.48–11.54, P = 0.007), severe tibiotalar joint effusion (OR = 5.90, 95% CI: 1.65–21.04, P = 0.006), extensive talar BMLs (OR = 5.11, 95% CI: 1.37–19.11, P = 0.015), a HADS score ≥ 8 (OR = 1.98, 95% CI: 1.61–2.43, P < 0.001), and a 10MWT time ≥ 10 seconds (OR = 2.09, 95% CI: 1.56–2.80, P < 0.001) were independent risk factors for conservative treatment failure requiring surgery. The predictive model demonstrated good discriminative ability, with an area under the ROC curve (AUC) of 0.840, a sensitivity of 0.733, and a specificity of 0.846, and showed satisfactory calibration. Conclusion Extensive talar BMLs, tibiotalar joint effusion, elevated anxiety and depression levels, and impaired walking function are independent predictors of conservative treatment failure in young and middle-aged male patients with a first-time ALAS. Early identification of these risk factors may facilitate risk stratification and optimize clinical decision-making regarding treatment strategies.
DOI: 10.21203/rs.3.rs-10048821/v1
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W7166834884
Cites: 35
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Related to: 10