Takao Masato, Oae Kazunori, Uchio Yuji, Ochi Mitsuo, Yamamoto Haruyasu
Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane 693-8501, Japan.
Am J Sports Med. 2005 Jun;33(6):814-23. doi: 10.1177/0363546504272688.
Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed.
A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle.
Case series; level of evidence, 4.
Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10 degrees , only the anterior talofibular ligament was reconstructed; if there was a 10 degrees or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed.
In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5 degrees +/- 1.7 degrees before surgery and 2.6 degrees +/- 0.8 degrees 2 years after surgery (P < .0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5 degrees +/- 1.5 degrees before surgery and 3.0 degrees +/- 0.5 degrees 2 years after surgery (P = .0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3 degrees +/- 1.4 degrees before surgery and 3.5 degrees +/- 0.8 degrees 2 years after surgery (P = .0060).
The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.
关于用于外侧韧带手术重建以治疗踝关节外侧不稳定的解剖学和微创操作的报道较少。此外，对于哪些韧带应该重建尚无标准。
一种使用干涉配合锚固系统对踝关节外侧韧带进行解剖重建，并根据距小腿关节和距下关节标准应力X线摄影结果确定哪些韧带需要重建的新技术，将有效治疗踝关节外侧不稳定。
病例系列；证据等级，4级。
21例踝关节外侧不稳定患者接受了使用所提出的干涉配合锚固系统的手术。对距下关节进行标准应力X线摄影，如果距跟角小于10度，则仅重建距腓前韧带；如果距跟角开口为10度或更大，则重建距腓前韧带和跟腓韧带。
在仅接受距腓前韧带重建的17例患者中，距小腿关节标准应力X线摄影的平均距骨倾斜角术前为14.5度±1.7度，术后2年为2.6度±0.8度（P <.0001）。对于4例同时重建了距腓前韧带和跟腓韧带的患者，平均距骨倾斜角术前为16.5度±1.5度，术后2年为3.0度±0.5度（P = .0015）。距下关节标准应力X线摄影的总体平均距跟角术前为11.3度±1.4度，术后2年为3.5度±0.8度（P = .0060）。
与踝关节外侧韧带的张力强度相比，所提出的系统具有几个优点，包括解剖重建、恢复正常稳定性和活动范围、重建过程中只需小切口以及肌腱移植物-骨隧道连接处有足够强度。
