Vienne Patrick, Schöniger Ralph, Helmy Naeder, Espinosa Norman
Uniklinik Balgrist, Orthopaedics, Forchstrasse 340, Zurich, 8008, Switzerland.
Foot Ankle Int. 2007 Jan;28(1):96-102. doi: 10.3113/FAI.2007.0018.
Chronic lateral ankle instability has been associated with varus deformity of the hindfoot, hyperactivity of the peroneus longus muscle, and insufficiency of the lateral ligaments. Many operative procedures have been described to correct this problem, but instability can recur if all contributing components are not treated. The purpose of this study was to offer an approach in the diagnosis and treatment of recurrent lateral ankle instability.
Eight consecutive patients (nine feet) were treated for recurrent chronic lateral ankle instability. The average age at surgery was 25 (range 8 to 37) years. All patients had prior operative procedures that failed and had persistent pain and functional instability of the ankle joint. After clinical and radiographic examination, lateralizing calcaneal osteotomy to correct the structured varus deformity and peroneus longus to peroneus brevis tendon transfer to add dynamic correction were done in all patients. A Broström ligament reconstruction was added in four feet. All patients were evaluated clinically and radiographically at an average followup of 37 months. Preoperatively and postoperatively patients were evaluated by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Score.
All patients were satisfied with the operation. The overall AOFAS-Score improved from 57 points preoperatively to 87 points postoperatively. Hindfoot alignment was restored to a valgus position at final evaluation.
Recurrent chronic lateral ankle instability often is associated with chronic hindfoot malalignment and leads to functional impairment and patient discomfort. Clinical examination should determine the causes of instability. Varus malalignment of the hindfoot, hyperactivity of the peroneus longus muscle, and insufficiency of the lateral ligaments should be assessed and treated in a combined operative procedure to correct structured, static and dynamic components of the instability. The preliminary results of this particular approach are encouraging.
慢性外侧踝关节不稳与后足内翻畸形、腓骨长肌亢进及外侧韧带功能不全有关。已有多种手术方法用于纠正该问题，但如果未对所有相关因素进行治疗，不稳仍可能复发。本研究旨在提供一种复发性外侧踝关节不稳的诊断和治疗方法。
连续8例患者（9足）接受复发性慢性外侧踝关节不稳的治疗。手术时的平均年龄为25岁（范围8至37岁）。所有患者既往手术均失败，踝关节持续疼痛且功能不稳。经临床和影像学检查后，所有患者均行跟骨外侧截骨以纠正结构性内翻畸形，并进行腓骨长肌至腓骨短肌肌腱转移以增加动态矫正。4足加做了布罗斯特伦韧带重建术。所有患者平均随访37个月，进行临床和影像学评估。术前及术后通过美国矫形足踝协会（AOFAS）评分对患者进行评估。
所有患者对手术均满意。AOFAS总分从术前的57分提高到术后的87分。末次评估时后足对线恢复至外翻位。
复发性慢性外侧踝关节不稳常与慢性后足对线不良有关，导致功能障碍和患者不适。临床检查应确定不稳的原因。应评估并通过联合手术治疗后足内翻对线不良、腓骨长肌亢进及外侧韧带功能不全，以纠正不稳的结构性、静态和动态因素。该特定方法的初步结果令人鼓舞。
