Maffulli Nicola, Ferran Nicholas A
Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
J Am Acad Orthop Surg. 2008 Oct;16(10):608-15. doi: 10.5435/00124635-200810000-00006.
Acute lateral ankle ligament injuries are common. If left untreated, they can result in chronic instability. Nonsurgical measures, including functional rehabilitation, are the management methods of choice for acute injuries, with surgical intervention reserved for high-demand athletes. Chronic lateral ankle instability is multifactorial. Failed nonsurgical management after appropriate rehabilitation is an indication for surgery. Of the many surgical options available, anatomic repair of the anterior talofibular and calcaneofibular ligaments is recommended when the quality of the ruptured ligaments permits. Anatomic reconstruction with autograft or allograft should be performed when the ruptured ligaments are attenuated. Ankle arthroscopy is an important adjunct to ligamentous repair and should be performed at the time of repair to identify and address intra-articular conditions associated with chronic ankle instability. Tenodesis procedures are not recommended because they may disturb ankle and hindfoot biomechanics.
急性外侧踝关节韧带损伤很常见。如果不进行治疗，可能会导致慢性不稳定。非手术措施，包括功能康复，是急性损伤的首选治疗方法，手术干预仅适用于对运动要求高的运动员。慢性外侧踝关节不稳定是多因素的。经过适当康复后非手术治疗失败是手术的指征。在众多可用的手术选择中，当断裂韧带质量允许时，建议对距腓前韧带和跟腓韧带进行解剖修复。当断裂韧带变薄时，应采用自体移植物或异体移植物进行解剖重建。踝关节镜检查是韧带修复的重要辅助手段，应在修复时进行，以识别和处理与慢性踝关节不稳定相关的关节内情况。不推荐进行肌腱固定术，因为它们可能会干扰踝关节和后足的生物力学。
