## 5 Results  
As recorded in the database of our department, from January 2013 to November 2017 fifty-four patients underwent minimally invasive reconstruction of the ATFL and CFL using semitendinosus tendon autograft and met the inclusion criteria. Three patients were then excluded due to the presence of concomitant cartilage, bone or tendon lesions, and two more patients were excluded for ankle/foot deformity. A total of forty-nine patients completed the baseline survey, but two of them were lost at follow up (Figure 4).  
A total of 47 patients were therefore enrolled in the present study, with 28 females and 19 males (40.4%M/59.6%F). The mean age of the patients was 40, ranging from 17 to 63.  
The mean follow up time was 80 months, ranging from 67.5 to 94.4 (Table 1).  
The average pre-operative VAS pain score was 5.6 (2-9), and the reduction at last follow up was to a mean value of 0.7 points (ranging from 0 to 7) (\(p\) < 0.05).  
Similarly, the mean AOFAS ankle and hindfoot score pre-operative result was 66.53 (ranging from 40 to 95), which increased significantly to 94 points (ranging from 88 to 100) at final follow up (\(p\) < 0.05).  
The UCLA score determined pre-operatively (after the onset of the pathology) showed an average value of 7 (ranging from 4 to 8). At final follow up, the increase in the UCLA score was up to 9.2 points (ranging from 6 to 10) (\(p\) < 0.05).  
With regard to the Karlsson--Peterson instability scale, the mean result found pre-operatively was 71 (ranging from 40 to 90), which improved up to a mean value of 87.9 (ranging from 70 to 90) post-operatively at last follow up (\(p\) < 0.05).  
In terms of the level of physical activity, the Halasi scale was determined prior to the onset of the pathology with a mean value of 4.3 points (ranging from 2 to 8), and was 4.5 points (ranging from 2 to 8) at final follow up (\(p\): 0.5). More specifically, in 34 cases, the patients were able to return to the same level of physical activity before the ankle injury,  
\begin{table}
\begin{tabular}{c c c} \hline \hline
**Characteristics** & **Average** & **Range** \\ \hline Age (years) & 42.1 & 23–63 \\ \hline Weight (kg) & 74.6 & 53–92 \\ \hline Height (m) & 1.7 & 1.64–1.85 \\ \hline BMI & 25.6 & 19–33.46 \\ \hline  & N & \% \\ \hline Male/Female & 19/28 & 40.4/59.6 \\ \hline Right/Left & 35/12 & 74.5/25.5 \\ \hline \hline \end{tabular}
\end{table}
Table 1: Description of patient characteristics.  
in 10 cases, the patients had an improved level of sport activity and in 3 cases, the level decreased after surgical treatment (Table 2).  
Figure 4: Patient enrollment flowchart.  
During this period of follow up, the procedure survival rate was 95.7%. We found two cases of recurrence of ankle sprain after surgical treatment (4.3%). (Figure 5) Both the patients were able to return to the pre-operative sport level as reported in terms of UCLA score and Halasi scale, but during activity, they experienced a new episode of ankle sprain. The time of recurrence was twelve months in one case and forty months in the other case. Both patients reported that they had never re-experienced ankle instability before the new episode and that the new ankle sprain happened because of a traumatic event during physical activity.