Groupe Chirurgical République-Grenoble-France, Foot and Ankle Surgery, Grenoble, France.
Foot Ankle Int. 2012 Dec;33(12):1079-86. doi: 10.3113/FAI.2012.1079.
Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap.
This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis.
A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17~mm. There was no deterioration of the articular surfaces after 11 years of follow-up.
To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability.
慢性不稳定是外侧踝关节扭伤的常见并发症。此外，患者通常存在未被识别的相关病变，影响踝关节和距下关节。许多稳定的手术技术已经被描述，每个技术都有不同的结果。本文报告了韧带再固定结合伸肌支持带瓣加强的长期结果。
这是一项回顾性、多中心研究。在平均随访 11 年后，对 150 例病例进行了回顾。使用 Karlsson 评分评估功能结果。术前和术后的放射学评估采用应力 X 线片测量内翻倾斜和前抽屉，并采用 Van Dijk 分级评估骨关节炎。使用 Stata 10 程序进行统计分析。
彻底的术前检查在 30%的病例中发现了距下关节的韧带损伤。在复查时，93%的患者满意。只有 4.8%的患者存在残余不稳定。对双侧踝关节的放射学分析显示，内翻倾斜的差异仅为 0.12°，前抽屉的差异为 0.17~mm。在 11 年的随访后，关节表面没有恶化。
据作者所知，这是报告的最大系列，随访时间最长。该技术解决了外侧踝关节和距下关节的不稳定，而不会牺牲腓肠肌腱。它可以防止创伤后关节炎的进展，并在患者满意度和残余不稳定方面提供优于其他报告技术的结果。
