Does prehabilitation with exercise improve clinical outcomes of arthroscopic modified Broström procedure in patients with chronic lateral ankle instability: a prospective cohort study

The arthroscopic modified Broström procedure (AMBP) is the gold-standard surgical treatment for chronic lateral ankle instability (CLAI). While postoperative rehabilitation is well-established, the impact of structured preoperative rehabilitation (prehabilitation) remains unclear. This observational study aimed to evaluate the mid-term effect of an exercise-based prehabilitation program on patient-reported outcomes, functional performance, and return to sports among CLAI patients undergoing AMBP. From January 2021 to December 2022, 276 patients with CLAI scheduled for AMBP were prospectively enrolled. Participants were assigned to either an experimental group, which underwent a 4-week supervised prehabilitation program focusing on peroneal strengthening, proprioception and balance training, and neuromuscular control, or a control group, which received standard care without prehabilitation. All patients received AMBP followed by the same postoperative rehabilitation. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), Karlsson Ankle Functional Score (KAFS), star excursion balance test (SEBT), single-leg stance test, ankle range of motion (ROM), and time to return to sports. Evaluations were performed preoperatively and at 3, 6, 12, and 24 months postoperatively. A total of 254 patients (92.0%) completed the 24-month follow-up. Both groups showed significant improvement in FAOS, FAAM, CAIT, and KAFS scores at all follow-up points. At the 2-year mark, the experimental group showed significantly higher scores in the total FAOS [92.4 (6.1) vs. 80.0 (8.9)], particularly in sports subscale [88.9 (7.5) vs. 82.1 (9.0)] and quality of life (QoL) subscale [85.2 (8.9) vs. 74.5 (12.8)]. Furthermore, the experimental group exhibited significantly greater improvements in FAAM sports activity subscale, CAIT, KAFS, anterior reach distance in the SEBT, normalized muscle activation in peroneus longus and soleus muscles during single leg stance test, ankle plantarflexion ROM, and time to return to sports. This non-randomized prospective cohort study indicates that an exercise-based prehabilitation before AMBP is associated with better patient-reported outcomes, enhanced functional recovery at 6 months, and more efficient return to sports, with patient-reported benefits maintained at 24 months. These findings warrant confirmation in randomized controlled trials considering potential selection bias. Chinese Clinical Trial Registry ChiCTR1900024780, date of registration: 2019-07-27, URL of the trial registration: https://www.chictr.org.cn/showproj.html?proj=41473 . Therapeutic Level II, Prospective Cohort Study.