Department of Orthopaedic Surgery, University of Michigan, 2098 S. Main St., Ann Arbor, MI 48103-5827, USA.
Foot Ankle Int. 2010 Nov;31(11):941-8. doi: 10.3113/FAI.2010.0941.
Patients with idiopathic cavovarus deformity and lateral ankle ligament instability often present with varying degrees of ankle arthritis. The purpose of this study was to determine whether the severity of degenerative change would impact the clinical outcome in patients treated operatively for both cavovarus deformity and lateral ankle ligament instability.
Twenty-two patients were treated with lateral ankle ligament reconstruction and realignment foot osteotomy. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson and Peterson (KP) scoring scale, Visual Analog Scale (VAS) for pain, and level of satisfaction were obtained. Preoperative and postoperative ankle radiographs were reviewed and graded using the van Dijk score. Patients with Grade 0 and I arthritis preoperatively were grouped together as no to minimal arthritis'' (Group 1) and those with Grade II and III arthritis preoperatively as moderate to severe arthritis'' (Group 2). There were 14 ankles in Group 1 and eight ankles in Group 2. Mean followup was 60.4 months.
Mean AOFAS and KP scores were significantly improved in Group 1 compared to Group 2 at latest followup, while VAS pain scale trended lower in Group 1. There were 12 excellent/good results, one fair result, and one poor result in Group 1. Patients in Group 2 had three excellent/good results, two fair results, and three poor results. One of 14 patients in Group 1 had progression of arthritis, while five of eight patients in Group 2 either had progression of arthritis or required an ankle fusion.
Patients treated with lateral ankle ligament reconstruction and cavovarus realignment osteotomy with no to minimal preoperative tibiotalar arthritis have higher clinical scores and increased satisfaction compared to patients with more advanced preoperative tibiotalar arthritis. A cautious and realistic approach should be followed when recommending surgical treatment for this patient population.
患有特发性内翻高弓畸形伴外侧踝关节韧带不稳定的患者常表现出不同程度的踝关节关节炎。本研究旨在确定退行性改变的严重程度是否会影响接受手术治疗内翻高弓畸形伴外侧踝关节韧带不稳定的患者的临床结果。
22 例患者接受外侧踝关节韧带重建和跟骨楔形截骨术治疗。采用美国矫形足踝协会（AOFAS）踝关节-后足评分、Karlsson 和 Peterson（KP）评分量表、疼痛视觉模拟评分（VAS）和满意度进行评估。术前和术后踝关节 X 线片进行回顾，并使用 van Dijk 评分进行分级。术前关节炎分级为 0 级和 1 级的患者归为“无至轻度关节炎”（1 组），术前关节炎分级为 2 级和 3 级的患者归为“中至重度关节炎”（2 组）。1 组有 14 个踝关节，2 组有 8 个踝关节。平均随访时间为 60.4 个月。
1 组的 AOFAS 和 KP 评分在末次随访时均显著高于 2 组，而 VAS 疼痛评分在 1 组中呈下降趋势。1 组中 12 例为优/良，1 例为可，1 例为差。2 组中，有 3 例为优/良，2 例为可，3 例为差。1 组中有 14 例患者中有 1 例出现关节炎进展，而 2 组中有 8 例中有 5 例患者关节炎进展或需要踝关节融合。
与术前存在更严重的距下关节炎的患者相比，接受外侧踝关节韧带重建和内翻高弓矫正截骨术治疗且术前距下关节炎为无至轻度的患者具有更高的临床评分和更高的满意度。对于这一患者群体，应采取谨慎和现实的方法来推荐手术治疗。
