Kerkhoffs G M, Blankevoort L, van Poll D, Marti R K, van Dijk C N
Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, Netherlands.
Clin Biomech (Bristol). 2001 Oct;16(8):635-43. doi: 10.1016/s0268-0033(01)00054-7.
To provide a clear overview of the literature on the relationship between increased lateral ankle ligament damage and anterior talocrural-joint laxity.
A systematic review of the literature.
Diagnostic methods for inversion injuries of the ankle have remained controversial throughout the years. An instrumented test for anterior talocrural-joint laxity could be a diagnostic tool for evaluation of anterior lateral ankle ligament function.
An advanced electronic database search using MEDLINE and EMBASE was performed to find studies describing the correlation between lateral ankle ligament damage and talocrural-joint laxity. Two reviewers assessed the methodological quality for each study and agreement was noted. Two reviewers extracted all relevant data with respect to methodology, motion constraints and laxity measurement.
The quality assessment resulted in 5 studies being scored as high quality and 5 as low quality. Different test devices were used to apply the load and measure the displacement. All in vitro tests applied a load to the calcaneus and subsequently measured the translation of the talus and/or calcaneus relative to the tibial dome. Rotation in the transversal and frontal plane was restricted in 8 tests. After analysis of the results presented by nine different studies, the mean value of anterior talocrural-joint laxity with intact ligaments is 4.2 mm. After sectioning of the anterior talofibular ligament, the mean anterior laxity value is 6.5 mm. The mean anterior laxity value after sectioning of the calcaneofibular ligament increases to 8.4 mm. The mean anterior laxity value with the foot in dorsal flexion (3.1 mm) is less than the mean value with the foot in neutral position (4.5 mm) or in plantar flexion (4.7 mm). The applied load and the anterior laxity values between the different studies vary greatly.
Each ligament section results in significantly increased talocrural-joint laxity. Talocrural-joint laxity can be used as a measure for damage to the anterior talofibular ligament and/or the calcaneofibular ligament. From this review, it is neither possible to give universal recommendations about the optimal flexion angle for testing talocrural-joint laxity as a measure for lateral ankle ligament function, nor to recommend the ideal load for performing the test.
The development of an instrumented test as a diagnostic tool for anterior talocrural-joint laxity in the clinical setting is near at hand and practicable.
全面概述有关外侧踝关节韧带损伤增加与距骨前关节松弛之间关系的文献。
对文献进行系统综述。
多年来，踝关节内翻损伤的诊断方法一直存在争议。一种用于检测距骨前关节松弛的仪器测试可能是评估外侧踝关节韧带功能的诊断工具。
使用MEDLINE和EMBASE进行了高级电子数据库搜索，以查找描述外侧踝关节韧带损伤与距骨关节松弛之间相关性的研究。两名评审员评估了每项研究的方法学质量并记录了一致性。两名评审员提取了所有与方法、运动限制和松弛测量相关的数据。
质量评估结果为5项研究被评为高质量，5项为低质量。使用了不同的测试设备来施加负荷并测量位移。所有体外测试都对跟骨施加负荷，随后测量距骨和/或跟骨相对于胫骨穹窿的平移。在8项测试中，横向和额面的旋转受到限制。在分析了9项不同研究给出的结果后，韧带完整时距骨前关节松弛的平均值为4.2毫米。切断距腓前韧带后，平均前向松弛值为6.5毫米。切断跟腓韧带后的平均前向松弛值增加到8.4毫米。足背屈时的平均前向松弛值（3.1毫米）小于足处于中立位（4.5毫米）或跖屈位（4.7毫米）时的平均值。不同研究之间施加的负荷和前向松弛值差异很大。
每条韧带切断都会导致距骨关节松弛显著增加。距骨关节松弛可作为距腓前韧带和/或跟腓韧带损伤的一种衡量指标。从本次综述来看，既无法就测试距骨关节松弛作为外侧踝关节韧带功能衡量指标的最佳屈曲角度给出通用建议，也无法推荐进行该测试的理想负荷。
一种用于临床环境中距骨前关节松弛诊断工具的仪器测试的开发即将实现且可行。
