Petrera Massimo, Dwyer Tim, Theodoropoulos John S, Ogilvie-Harris Darrell J
University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada.
University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada Women's College Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada.
Am J Sports Med. 2014 Jul;42(7):1542-8. doi: 10.1177/0363546514530668. Epub 2014 Apr 25.
Anatomic techniques of ankle ligament repair have the advantage of restoring the anatomy and kinematics of the joint. This study presents a technique for anatomic reconstruction of the lateral ligament complex by way of lateral ligament advancement using suture anchors associated with immediate protected full weightbearing; 2- to 5-year clinical outcomes are reported.
This technique of providing an anatomic reconstruction with a secure fixation will enable early rehabilitation with immediate, protected weightbearing, with favorable outcomes.
Case series; Level of evidence, 4.
Fifty-five patients with chronic lateral ankle instability who failed nonoperative management underwent modified Broström repair (lateral ligament fibular advancement) between 2005 and 2008. The anterior talofibular ligament and calcaneofibular ligament were released from the fibula and advanced using 2 double-loaded metallic suture anchors (3.5 mm). Full weightbearing in a walking boot was allowed from the first postoperative day. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score. Complication, failure (recurrent instability), and return-to-sport rates were also recorded.
Six patients (11%) were lost to follow-up, leaving a study group of 49 patients (23 men, 26 women). The mean age at the time of surgery was 25 years (range, 18-37 years), with a mean duration of symptoms of 1.8 years (range, 6 months to 5 years). The mean follow-up time was 42 months (range, 24-60 months). Significant improvement was seen in the Foot and Ankle Outcome Score from preoperatively to postoperatively (from 36 to 75.4, P < .001): the pain subscale improved from 35 to 75 (P < .001), the symptom subscale from 29 to 77 (P = .01), the function subscale from 45 to 77 (P < .001), the function in sports and recreation subscale from 38 to 70 (P < .001), and the foot and ankle-related quality of life subscale from 35 to 78 (P < .001). No significant difference in range of motion with the contralateral side was seen (P = .34). The failure rate was 6%, with 3 patients reporting residual instability after a traumatic retear. Two cases of superficial wound infection were seen. One case of temporary neurapraxia of the superficial peroneal nerve was observed. The return-to-sport rate was 94%.
This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement using suture anchor fixation is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weightbearing.
踝关节韧带修复的解剖技术具有恢复关节解剖结构和运动学的优势。本研究介绍了一种通过使用缝线锚钉进行外侧韧带推进来对外侧韧带复合体进行解剖重建的技术，并允许立即进行保护性全负重；报告了2至5年的临床结果。
这种提供解剖重建并牢固固定的技术将能够实现早期康复并立即进行保护性负重，从而获得良好的结果。
病例系列；证据等级，4级。
2005年至2008年期间，55例非手术治疗失败的慢性外侧踝关节不稳患者接受了改良的布罗斯特罗姆修复术（外侧韧带腓骨推进术）。将距腓前韧带和跟腓韧带从腓骨上松解，并使用2个双负荷金属缝线锚钉（3.5毫米）进行推进。术后第一天即可在步行靴中进行全负重。术前及至少2年随访时使用足踝结果评分对患者进行评估。还记录了并发症、失败（复发性不稳）和重返运动率。
6例患者（11%）失访，剩余49例患者纳入研究组（23例男性，26例女性）。手术时的平均年龄为25岁（范围18至37岁），平均症状持续时间为1.8年（范围6个月至5年）。平均随访时间为42个月（范围24至60个月）。足踝结果评分从术前到术后有显著改善（从36分提高到75.4分，P <.001）：疼痛亚量表从35分提高到75分（P <.001），症状亚量表从29分提高到77分（P =.01），功能亚量表从45分提高到77分（P <.001），运动和娱乐功能亚量表从38分提高到70分（P <.001），足踝相关生活质量亚量表从35分提高到78分（P <.001）。与对侧相比，活动范围无显著差异（P =.34）。失败率为6%，3例患者在创伤性再撕裂后报告有残余不稳。出现2例表浅伤口感染。观察到1例腓浅神经暂时性神经失用。重返运动率为94%。
本研究表明，使用缝线锚钉固定进行距腓前韧带和跟腓韧带推进是治疗慢性外侧踝关节不稳的有效方法，并允许立即负重。
