Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, Brazil.
Am J Sports Med. 2011 Nov;39(11):2381-8. doi: 10.1177/0363546511416069. Epub 2011 Jul 29.
Lateral ankle sprains account for 85% of ankle lesions.
Combined open and arthroscopic procedures could improve the diagnosis and management of intra-articular lesions and allow surgeons to perform minimally invasive anatomic reconstruction of the lateral ligament complex.
Case series; Level of evidence, 4.
Forty consecutive patients underwent ankle arthroscopy for recurrent (2 or more episodes) lateral ankle instability unresponsive to nonoperative measures. The clinical diagnosis of mechanical instability was confirmed at imaging (plain radiographs and magnetic resonance imaging [MRI]) and arthroscopic assessment. All patients underwent arthroscopic Broström-Gould repair for management of lateral ankle instability; secondary lesions were also managed. Postoperatively, the American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status; clinical examination and conventional radiographs were performed in all patients.
Thirty-eight patients were reviewed at an average postoperative follow-up of 9.8 years. The mean AOFAS score was 90 (range, 44-100) at the last follow-up. No significantly different outcomes were found in patients who had undergone microfractures for management of grade III to IV cartilage lesions compared with patients with no cartilage lesions. Postoperative AOFAS scores were graded as excellent and good in almost all patients (94.7%). Concerning failure rate, 2 patients (5.3%) reported a low AOFAS score: one patient underwent soft tissue removal for anterior impingement, and one received simultaneous medial ankle instability repair.
The arthroscopic Broström-Gould-assisted technique could be a viable alternative to the gold-standard Broström-Gould procedure for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. Prospective randomized controlled trials are needed.
外踝扭伤占踝关节损伤的 85%。
开放性和关节镜联合手术可以改善关节内病变的诊断和处理，并使外科医生能够对外侧韧带复合体进行微创解剖重建。
病例系列；证据水平，4 级。
40 例连续患者因复发性（2 次或以上）外侧踝关节不稳定而接受踝关节镜检查，这些患者对非手术措施无反应。机械不稳定的临床诊断在影像学（平片和磁共振成像[MRI]）和关节镜评估中得到证实。所有患者均行关节镜下 Broström-Gould 修复术治疗外侧踝关节不稳定；同时处理次要病变。术后采用美国矫形足踝协会（AOFAS）评分评估功能状态；所有患者均行临床检查和常规 X 线检查。
38 例患者平均术后随访 9.8 年。末次随访时，AOFAS 平均评分为 90 分（范围，44-100）。接受微骨折治疗 III 级至 IV 级软骨病变的患者与无软骨病变的患者相比，其结果无显著差异。术后 AOFAS 评分几乎所有患者（94.7%）均为优和良。关于失败率，2 例（5.3%）患者 AOFAS 评分较低：1 例患者因前撞击行软组织切除，1 例患者行内侧踝关节不稳定修复。
关节镜下 Broström-Gould 辅助技术可能是慢性外侧踝关节不稳定解剖修复和关节内病变处理的金标准 Broström-Gould 手术的可行替代方法。需要前瞻性随机对照试验。
