The Royal London Hospital (Mile End), 275 Bancroft Road, London, UK.
Am J Sports Med. 2013 Apr;41(4):858-64. doi: 10.1177/0363546512474967. Epub 2013 Feb 6.
Lateral ankle sprains may result in pain and disability in the short term, decreased sport activity and early retirement from sports in the mid term, and secondary injuries and development of early osteoarthritis to the ankle in the long term.
This combined approach to chronic lateral instability and intra-articular lesions of the ankle is safe and in the long term maintains mechanical stability, functional ability, and a good level of sport activity.
Case series; Level of evidence, 4.
We present the long-term outcomes of 42 athletes who underwent ankle arthroscopy and anterior talofibular Broström repair for management of chronic lateral ankle instability. We assessed in all patients preoperative and postoperative anterior drawer test and side-to-side differences, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Kaikkonen grading scales. Patients were asked about return to sport and level of activity. Patients were also assessed for development of degenerative changes to the ankle, and preoperative versus postoperative findings were compared.
Thirty-eight patients were reviewed at an average of 8.7 years (range, 5-13 years) after surgery; 4 patients were lost to follow-up. At the last follow-up, patients were significantly improved for ankle laxity, AOFAS scores, and Kaikkonen scales. The mean AOFAS score improved from 51 (range, 32-71) to 90 (range, 67-100), and the mean Kaikkonen score improved from 45 (range, 30-70) to 90 (range, 65-100). According to outcome criteria set preoperatively, there were 8 failures by the AOFAS score and 9 by the Kaikkonen score. Twenty-two (58%) patients practiced sport at the preinjury level, 6 (16%) had changed to lower levels but were still active in less demanding sports (cycling and tennis), and 10 (26%) had abandoned active sport participation although they still were physically active. Six of these patients did not feel safe with their ankle because of the occurrence of new episodes of ankle instability. Of the 27 patients who had no evidence of degenerative changes preoperatively, 8 patients (30%) had radiographic signs of degenerative changes (5 grade I and 3 grade II) of the ankle; 4 of the 11 patients (11%) with preexisting grade I changes remained unchanged, and 7 patients (18%) had progressed to grade II. No correlation was found between osteoarthritis and status of sport activity (P = .72).
Combined Broström repair and ankle arthroscopy are safe and allow most patients to return to preinjury daily and sport activities.
外踝扭伤可能导致短期疼痛和残疾、中期运动活动减少和提前退役、长期继发性损伤和踝关节早期骨关节炎。
这种治疗慢性外侧不稳定和踝关节内病变的综合方法是安全的，从长远来看，它可以保持机械稳定性、功能能力和良好的运动水平。
病例系列；证据水平，4 级。
我们介绍了 42 名运动员接受踝关节镜检查和前距腓韧带 Broström 修复术治疗慢性外侧踝关节不稳定的长期结果。我们在所有患者中评估了术前和术后的前抽屉试验和侧-侧差异、美国矫形足踝协会（AOFAS）评分和 Kaikkonen 分级。询问患者重返运动和活动水平。还评估了患者踝关节退行性变化的发生情况，并比较了术前和术后的发现。
38 例患者在手术后平均 8.7 年（范围，5-13 年）进行了回顾性分析；4 例患者失访。在最后一次随访时，患者的踝关节松弛度、AOFAS 评分和 Kaikkonen 评分均显著改善。AOFAS 评分平均从 51（范围，32-71）提高到 90（范围，67-100），Kaikkonen 评分平均从 45（范围，30-70）提高到 90（范围，65-100）。根据术前设定的结果标准，AOFAS 评分有 8 例失败，Kaikkonen 评分有 9 例失败。22 例（58%）患者恢复到受伤前的运动水平，6 例（16%）转为低水平运动，但仍积极参加要求较低的运动（骑自行车和网球），10 例（26%）放弃了积极的运动参与，尽管他们仍保持身体活跃。其中 6 名患者因踝关节反复不稳定而感到不安全。在 27 例术前无退行性改变证据的患者中，8 例（30%）出现踝关节退行性改变的影像学征象（5 级 I 和 3 级 II）；11 例（11%）原有 1 级改变的患者无变化，7 例（18%）进展为 2 级。关节炎与运动活动状态之间无相关性（P =.72）。
Broström 修复联合踝关节镜检查是安全的，可以使大多数患者恢复到受伤前的日常和运动活动水平。
