SLR - November 2022 - Nickolas Grimes, DPM
Title: Break Reaction Time after Conservatively Treated Ligament Ruptures of the AnkleReference: Jeske HC, Hirnsperger C, Perwanger F, Dammerer D, Giesinger J, Schlumberger M, Liebensteiner M. Break Reaction Time after Conservatively Treated Ligament Ruptures of the Ankle. Injury. 2021 Aug;52(8):2463-2468.
Reviewed By: Nickolas Grimes, DPM
Residency Program: Kaiser S.F. Bay Area Foot & Ankle, Oakland, CA
Podiatric Relevance: Ankle sprains are one of the most common injuries treated by foot and ankle surgeons. Treating physicians are regularly confronted with when a patient can safely resume driving after an ankle sprain, however there are no well-established guidelines for determining when it is safe to drive after injury or treatment. Braking ability is commonly reported in terms of braking reaction time (BRT) which has been utilized as an objective measure to determine when a patient may be safe to return to driving. This study evaluated how long patients with ligament ruptures of the ankle should wait until they can safely drive a car without being a hazard to themselves or other drivers.
Methods: A prospective case control study was performed with 30 patients with grade II and III ligament injuries of the right ankle versus 30 healthy volunteers. Prospective outcomes were then evaluated by using Brake reaction time (BRT), Neurologic Reaction Time (NRT), Foot Transfer Time (FTT), and Brake Travel Time (BTT) were assessed using a custom-made driving simulator. BRT was assessed two, four and six weeks after injury. Simultaneously, the American Orthopedic Foot and Ankle Society Ankle Hindfoot Score (AOFAS-AHS) was assessed.
Results: At two weeks, the patients with grade II and III right ankle sprains had significantly longer BRT compared to the healthy controls. At four weeks, the patients with grade II and III ankle sprains and the healthy volunteer groups had no statistically significant differences in BRT, NRT, FTT, or BTT. At this time, the BRT of both groups was also well below the recommendations of road authorities. All patients with sufficient BRTs had an AOFAS-AHS score of ≥81 points.
Conclusions: There were no significantly significant difference found at four weeks post injury, patients generally had a sufficient BRT to drive in traffic safely. Since all patients with sufficient BRTs had an AOFAS-AHS score of ≥81 points, the AOFAS-AHS score can regarded as an adequate screening tool to evaluate which patients are ready to safely operate motor vehicles earlier.