Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
J Bone Joint Surg Am. 2010 Oct 20;92(14):2375-86. doi: 10.2106/JBJS.I.00869.
Ankle sprains may damage both the lateral ligaments of the hindfoot and the osteochondral tissue of the ankle joint. When nonoperative treatment fails, operative approaches are indicated to restore both native motion patterns at the hindfoot and ankle joint contact mechanics. The goal of the present study was to determine the effect of lateral ligament injury, repair, and reconstruction on ankle joint contact mechanics and hindfoot motion patterns.
Eight cadaveric specimens were tested with use of robotic technology to apply combined compressive (200-N) and inversion (4.5-Nm) loads to the hindfoot at 0° and 20° of plantar flexion. Contact mechanics at the ankle joint were simultaneously measured. A repeated-measures experiment was designed with use of the intact condition as control, with the other conditions including sectioned anterior talofibular and calcaneofibular ligaments, the Broström and Broström-Gould repairs, and graft reconstruction.
Ligament sectioning decreased contact area and caused a medial and anterior shift in the center of pressure with inversion loads relative to those with the intact condition. There were no significant differences in inversion or coupled axial rotation with inversion between the Broström repair and the intact condition; however, medial translation of the center of pressure remained elevated after the Broström repair relative to the intact condition. The Gould modification of the Broström procedure provided additional support to the hindfoot relative to the Broström repair, reducing inversion and axial rotation with inversion beyond that of intact ligaments. There were no significant differences in center-of-pressure excursion patterns between the Broström-Gould repair and the intact ligament condition, but this repair increased contact area beyond that with the ligaments intact. Graft reconstruction more closely restored inversion motion than did the Broström-Gould repair at 20° of plantar flexion but limited coupled axial rotation. Graft reconstruction also increased contact areas beyond the lateral ligament-deficient conditions but altered center-of-pressure excursion patterns relative to the intact condition.
No lateral ankle ligament reconstruction completely restored native contact mechanics of the ankle joint and hindfoot motion patterns.
踝关节扭伤可能会同时损伤后足的外侧韧带和踝关节的软骨骨组织。当非手术治疗失败时，需要手术来恢复后足和踝关节的原有运动模式和接触力学。本研究的目的是确定外侧韧带损伤、修复和重建对踝关节接触力学和后足运动模式的影响。
使用机器人技术对 8 个尸体标本进行测试，在后足在 0°和 20°跖屈位时施加 200-N 的压缩和 4.5-Nm 的内翻复合载荷。同时测量踝关节的接触力学。设计了一个重复测量实验，以完整状态作为对照，其他状态包括切断前距腓韧带和跟腓韧带、Broström 和 Broström-Gould 修复以及移植物重建。
韧带切断后，与完整状态相比，在施加内翻负荷时，接触面积减小，压力中心向内侧和前侧移位。Broström 修复与完整状态相比，内翻和伴内翻的轴向旋转没有显著差异；然而，Broström 修复后压力中心的内侧平移仍高于完整状态。Broström 手术的 Gould 改良对后足提供了额外的支撑，使内翻和伴内翻的旋转减少，超过了完整韧带的程度。Broström-Gould 修复与完整韧带状态相比，压力中心的偏移模式没有显著差异，但这种修复增加了接触面积。与 Broström-Gould 修复相比，移植物重建更接近恢复 20°跖屈时的内翻运动，但限制了伴内翻的轴向旋转。移植物重建也增加了接触面积，超过了外侧韧带缺失的状态，但相对于完整状态改变了压力中心的偏移模式。
没有任何一种外侧踝关节韧带重建可以完全恢复踝关节和后足运动模式的原有接触力学。
