Vega Jordi, Peña Fernando, Golanó Pau
Foot and Ankle Unit, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1116-23. doi: 10.1007/s00167-014-3454-y. Epub 2014 Nov 28.
The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain.
From 2008 to 2010, records of all patients who underwent ankle joint arthroscopy with anterolateral pain and functional instability after an ankle sprain were reviewed. A systematic arthroscopic examination of the intra-articular structures of the ankle joint was performed. Location and characteristics of the injuries were identified and recorded.
A total of 36 ankle arthroscopic procedures were reviewed. A soft-tissue occupying mass over the lateral recess was present in 18 patients (50%). A partial injury of the anterior talofibular ligament (ATFL) was observed in 24 patients (66.6%). Cartilage abrasion due to the distal fascicle of the anteroinferior tibiofibular ligament coming into contact with the talus was seen in 21 patients (58.3%), but no thickening of the ligament was observed. Injury to the intra-articular posterior structures, including the transverse ligament in 19 patients (52.7%) and the posterior surface of the distal tibia in 21 patients (58.3%), was observed.
Intra-articular pathological findings have been observed in patients affected by anterolateral pain after an ankle sprain. Despite no demonstrable abnormal lateral laxity, morphologic ATFL abnormality has been observed on arthroscopic evaluation. An injury of the ATFL is present in patients with chronic anterolateral pain and functional instability after an ankle sprain. A degree of microinstability due to a deficiency of the ATFL could explain the intra-articular pathological findings and the patients' complaints.
IV.
本研究旨在确定哪些关节内损伤与踝关节扭伤后的慢性前外侧疼痛和功能不稳相关。
回顾2008年至2010年所有因踝关节扭伤后出现前外侧疼痛和功能不稳而接受踝关节镜检查的患者记录。对踝关节的关节内结构进行系统的关节镜检查。确定并记录损伤的位置和特征。
共回顾了36例踝关节镜手术。18例患者（50%）在外侧隐窝处有软组织占位性肿块。24例患者（66.6%）观察到距腓前韧带（ATFL）部分损伤。21例患者（58.3%）可见下胫腓前韧带远侧束与距骨接触导致的软骨磨损，但未观察到韧带增厚。观察到关节内后部结构损伤，包括19例患者（52.7%）的横韧带和21例患者（58.3%）的胫距关节面后部。
踝关节扭伤后出现前外侧疼痛的患者存在关节内病理表现。尽管未发现明显的外侧松弛异常，但在关节镜评估中观察到了形态学上的ATFL异常。踝关节扭伤后出现慢性前外侧疼痛和功能不稳的患者存在ATFL损伤。ATFL不足导致的一定程度的微不稳可以解释关节内病理表现和患者的症状。
IV级。
