Richter J, Volz R, Immendörfer M, Schulz M
Zentrum für Arthroskopie und spezielle Gelenkchirurgie, Klinik für Sportorthopädie und arthroskopischen Chirurgie der Orthopädischen Klinik Markgröningen, Kurt Lindemannweg 10, 71706, Markgröningen, Deutschland.
Oper Orthop Traumatol. 2012 Feb;24(1):50-60. doi: 10.1007/s00064-011-0126-7.
Reconstruction of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligament in patients with chronic lateral ankle instability.
Symptomatic chronic lateral ankle instability.
Bony malalignment, advanced arthritic changes of the ankle joint, diabetic foot syndrome.
Reconstruction of the ATFL and CFL with a free gracilisor or semitendinosus tendon graft through a V-shaped tunnel at the insertion site of the ATFL on the talar neck as well as a transfibular tunnel directed anterior to posterior through the fibula tip to a blind ending tunnel in the calcaneus at the insertion site of the CFL. Insertion of the graft through the talar tunnel, passing both graft ends through the fibular tunnel to the calcaneus. Fixation with a bioabsorbable screw.
Short leg cast for 10-14 days and partial weight-bearing. Afterwards ankle brace for 6 weeks and functional physical therapy.
From December 2003 to August 2005, reconstruction of the ATFL and CFL with a hamstring tendon autograft was performed in 20 patients with chronic lateral instability of the ankle joint. All patients were evaluated after a mean follow-up time of 1.8 years (15-36 months). Clinical evaluation referred to the AOFAS score. Stress radiography was performed for objective assessment of lateral ankle stability. Postoperatively 19 of 20 patients reported good subjective stability with no further ankle sprains. The mean postoperative AOFAS score was 92 of 100 points (72-100). Stress radiography showed a significant reduction of both lateral ankle instability and talar tilt.
对慢性外侧踝关节不稳患者进行距腓前韧带（ATFL）和跟腓韧带（CFL）重建。
有症状的慢性外侧踝关节不稳。
骨排列不齐、踝关节晚期关节炎改变、糖尿病足综合征。
通过在距骨颈处ATFL附着点的V形隧道以及从前向后穿过腓骨尖至跟骨上CFL附着点处盲端隧道的经腓骨隧道，用游离股薄肌或半腱肌肌腱移植物重建ATFL和CFL。将移植物经距骨隧道插入，使移植物两端穿过腓骨隧道至跟骨。用可吸收螺钉固定。
短腿石膏固定10 - 14天并部分负重。之后佩戴踝关节支具6周并进行功能物理治疗。
2003年12月至2005年8月，对20例慢性外侧踝关节不稳患者采用自体腘绳肌腱进行ATFL和CFL重建。所有患者在平均随访1.8年（15 - 36个月）后接受评估。临床评估采用美国足踝外科协会（AOFAS）评分。进行应力位X线检查以客观评估外侧踝关节稳定性。术后20例患者中有19例报告主观稳定性良好，无进一步踝关节扭伤。术后AOFAS平均评分为100分中的92分（72 - 100分）。应力位X线检查显示外侧踝关节不稳和距骨倾斜均显著减轻。
