Ferran Nicholas A, Oliva Francesco, Maffulli Nicola
Department of Trauma and Orthopaedic Surgery, Lincoln County Hospital, Lincoln, UK.
Sports Med Arthrosc Rev. 2009 Jun;17(2):139-45. doi: 10.1097/JSA.0b013e3181a3d790.
Acute ankle sprains are common, and if inadequately treated may result in chronic instability. Lateral ankle injuries are most common, with deltoid injuries rare and associated with ankle fractures/dislocation. Medial ankle instability is rare. Functional management of acute lateral ankle sprains is the treatment of choice, with acute ligament repair reserved for athletes. Chronic lateral ankle instability is initially managed conservatively, however, failure of rehabilitation is an indication for surgical management. Nonanatomic tenodesis reconstructions have poor long-term results, sacrifice peroneal tendons, and disrupt normal ankle and hindfoot biomechanics. 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 ligaments are attenuated. The role of arthroscopic reconstruction is evolving. Ankle arthroscopy should be performed at the time of repair or reconstruction and should address any other intra-articular causes of pain.
急性踝关节扭伤很常见，若治疗不当可能导致慢性不稳定。外侧踝关节损伤最为常见，三角韧带损伤罕见，且与踝关节骨折/脱位相关。内侧踝关节不稳定很少见。急性外侧踝关节扭伤的功能管理是首选治疗方法，急性韧带修复仅适用于运动员。慢性外侧踝关节不稳定最初采用保守治疗，然而，康复失败是手术治疗的指征。非解剖学腱固定重建的长期效果不佳，会牺牲腓骨肌腱，并破坏正常的踝关节和后足生物力学。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。关节镜重建的作用正在不断发展。应在修复或重建时进行踝关节镜检查，并应处理任何其他关节内疼痛原因。
