Grégoire Rougereau

Background/Objectives: Fear of reinjury and impaired psychological readiness frequently impede return to sport following lateral ankle ligament surgery. This study aimed to analyze the correlation between kinesiophobia and psychological readiness to return to sport before and after intensive rehabilitation in competitive athletes following lateral ankle ligament repair or reconstruction (LALRR). Methods: A prospective longitudinal pre-post observational study was conducted at a specialized sports rehabilitation center between January 2021 and January 2024. Forty-eight competitive athletes (Tegner score ≥ 7) who underwent LALRR completed a 3-week inpatient rehabilitation program (7 h daily). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (TSK-17, TSK-13, TSK-11, and subscales), and psychological readiness was measured using the Ankle Ligament Reconstruction–Return to Sport after Injury (ALR-RSI) score at admission and discharge. Results: Cross-sectional analysis demonstrated weak to moderate negative correlations between ALR-RSI and TSK versions at baseline (rho = −0.28 to −0.43) and at discharge (rho = −0.20 to −0.60; TSK−13: rho = −0.60, 95% CI [−0.77, −0.34], p < 0.0001). Following rehabilitation, ALR-RSI scores significantly improved from 69.8 ± 17.3 to 76.1 ± 17.6 (p = 0.009), while TSK-17 scores decreased from 36.9 ± 7.8 to 33.2 ± 7.3 (p = 0.0001). However, the longitudinal correlation between individual change scores was weak and non-significant (rho = −0.15, 95% CI [−0.41, 0.11], p = 0.32). Conclusions: Kinesiophobia and psychological readiness exhibit weak to moderate inverse correlations cross-sectionally. However, no statistically significant association was detected between changes in kinesiophobia and psychological readiness in this sample (rho = −0.15, p = 0.32). These metrics capture distinct psychological aspects, and both should be monitored independently when assessing athletes prior to sports resumption.

Purpose: We evaluate the relationship between preoperative anxiety, as measured by the Surgical Fear Questionnaire (SFQ), and postoperative pain intensity during the first three days following arthroscopic ankle ligament reconstruction. A secondary objective was to determine whether preoperative anxiety levels are associated with failure to reach the Patient Acceptable Symptom State (PASS) threshold for pain by postoperative day 3. Methods: A prospective cohort of 68 patients undergoing anatomic arthroscopic ankle lateral ligament reconstruction between January 2023 and March 2025 was assessed. Patients were categorized into high- and low-anxiety groups based on a tertile distribution of SFQ scores, with a threshold of 45. Pain intensity was measured using the Visual Analog Scale (VAS) on days 0, 1, 2, and 3 postoperatively. The proportion of patients with unacceptable pain (VAS > 3) according to the patient’s acceptable symptom state was compared between groups. A receiver operating characteristic (ROC) curve identified the optimal SFQ threshold for discriminating PASS achievement on day 3. Odds ratios were calculated using logistic regression. Results: A total of 68 patients were included (34 in each group). The mean age was 32.9 ± 10.5 years in the high-anxiety group and 33.1 ± 9.9 years in the low-anxiety group (p = 0.747). The mean SFQ score was 58.9 ± 11.9 in the high-anxiety group and 28.0 ± 10.8 in the low-anxiety group (p < 0.001). There were no significant differences between groups in demographic characteristics. Patients in the high-anxiety group reported significantly higher VAS scores at all postoperative time points. The proportion failing to achieve PASS on day 3 was also significantly greater in the high-anxiety group (67.6% vs. 35.3%, p = 0.015). An SFQ threshold of 46 discriminated PASS status with an AUC of 0.70. Patients with SFQ ≥ 46 had more than triple the odds of not achieving PASS (OR = 3.39; 95% CI: 1.26–9.59, p = 0.017). Conclusions: Preoperative anxiety is significantly associated with early postoperative pain and pain acceptability following arthroscopic ankle ligament reconstruction. Identifying and managing high-anxiety patients preoperatively may improve pain outcomes and patient satisfaction.

Background: This cadaveric study aimed to assess the biomechanical impact of functional hallux limitus (FHLim), identified using the functional stretch test, on first metatarsophalangeal joint (MTP1) mobility and joint pressures, as well as on the first cuneometatarsal joint (C1M1). A secondary objective was to evaluate the effect of retrotalar pulley section of the flexor hallucis longus (FHL) tendon on these parameters. Methods: Seventeen cadaveric feet from 9 donors were analyzed. Each specimen was assessed in a resting position and during a functional stretch test, defined as passive hallux dorsiflexion performed with the ankle maintained in dorsiflexion to reproduce functional loading conditions. MTP1 mobility and intraarticular pressures at the MTP1 and C1M1 joints were measured before and after sectioning of the FHL retrotalar pulley. Results: Maximum dorsiflexion mobilities in stretch test position in the FHLim group were significantly increased after pulley section ( P < .001). Increased MTP1 pressure was found in the stretch test position in case of FHLim compared with controls in the neutral position ( P = .02), and in the 20° dorsiflexion position ( P = .02). There was a greater differential pressure in C1M1 joint before/after sectioning of the pulley in the FHLim group, whatever the position of the MTP1 in stretch test ( P < .05). The amount of pressure reduction in MTP1 joint after pulley section in dorsiflexion was correlated with the severity of maximal dorsiflexion deficit in the stretch test position before pulley section ( r = 0.51; P = .04). Conclusion: In this cadaveric model, FHL tenodesis at the retrotalar pulley restricted functional MTP1 dorsiflexion and increased joint pressures. Retrotalar pulley section corrected this biomechanical constraint and normalized MTP1 pressures relative to controls, supporting its role as a contributing mechanism in functional hallux limitus. Clinical Relevance: This cadaveric study provides direct biomechanical evidence linking FHL retrotalar pulley impingement to elevated MTP1 joint pressures, supporting pulley release as a rational surgical target in functional hallux limitus.

Background: Hallux valgus is a common forefoot deformity. Sensory complications after correction can result from iatrogenic injury to the medial branch of the medial dorsal cutaneous nerve (MDCNm), lateral dorsal cutaneous nerve (LDCN), medial plantar cutaneous nerve (MPCN), and lateral plantar cutaneous nerve (LPCN). We synthesized evidence and landmarks to aid nerve identification and reduce injury. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and Cochrane were searched to February 2025 using ‘nerve anatomy’, ‘hallux valgus’ and ‘bunion’. English/French studies describing course, measurements or localization of hallux sensory nerves from the first tarsometatarsal to interphalangeal joints were included. Results: From 863 records, 13 studies were included comprising cadaveric, imaging, and clinical series with both normal and hallux valgus feet. Evidence was most robust for MDCNm localization. Palpation during resisted hallux extension and targeted ultrasonography were reported as low-cost methods to define the MDCNm in relation to the extensor hallucis longus (EHL). Palpation showed 100% sensitivity (positive predictive value [PPV] 99%), whereas novice ultrasonography achieved 75% sensitivity (PPV 100%) in cadaveric feet before dissection. At the metatarsophalangeal (MTP) level, a transverse ‘clock-face’ reference (EHL at 12 o’clock) typically locates the MDCNm between 10 and 12 o’clock for a right foot. A communicating dorsoplantar ‘sentinel’ vein crosses the MDCNm about 2 cm proximal to MTP, with the nerve running deep to the vein. Limited data place the LDCN at 11-12, LPCN at 5-6 and MPCN at 7-8 o’clock. Most maps were derived from non-deformed feet. Hallux valgus severity shifts the MDCNm-EHL intersection proximally and may widen the medial danger zone to ~19 mm. Ultrasonography suggests MPCN lies within 3 to 4 mm of the metatarsal head and medial sesamoid, helping define capsulotomy limits; data for LPCN remain still limited. Conclusion: Combining palpation, ultrasonography and vein-based landmarks with awareness of axial danger zones may reduce sensory nerve injury during hallux valgus surgery; clinical validation in deformed feet remains necessary.