Lee Byung Hoon, Choi Kyung-Hwa, Seo Dong Yeon, Choi Sang Min, Kim Gab Lae
Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, Korea.
Hallym Research Institute of Clinical Epidemiology, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do, 200-702, Korea.
Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1029-39. doi: 10.1007/s00167-016-4037-x. Epub 2016 Feb 11.
To incorporate a diagnostic technique for measuring subtalar motion, namely "talar rotation", into the manual supination-anterior drawer stress radiographs for evaluation of the severity of rotational instability, and to determine its clinical relevance.
Sixty-six patients with combined injuries of the anterior talofibular (ATFL) and calcaneofibular ligament (CFL) underwent three bilateral manual stress radiographs, and mean increments of anterior talar translation (mm), talar tilt (°), and talar rotation (%) in the injured ankle compared to the normal opposite side were measured with the technique. Intraobserver and interobserver reliability of each measure was assessed, and the difference in the degree of increments was compared according to the presence of additional cervical ligament insufficiency.
Ankle stress radiographic intraobserver and interobserver agreement was ICC = 0.91 and 0.82 for talar rotation (%), ICC = 0.64 and 0.51 for anterior talar translation, and ICC = 0.78 and 0.71 for talar tilt angle, respectively. In group 2 including patients with combined injuries of the ATFL and CFL along with additional cervical ligament insufficiency, a significantly higher increment of talar rotation, mean 6.4% (SD 3.4%), was observed compared to that of talar rotation, mean 4.1% (SD 2.7 ), in the other group (group 1) with an intact cervical ligament (p < 0.001).
A new comprehensive stress radiographic technique for diagnosis of chronic lateral ankle instability presented in this study might be a reliable and representable measurement tool to assess additional injury or instability of the subtalar joint.
Prospective cohort study, Level II.
将一种测量距下关节运动的诊断技术，即“距骨旋转”，纳入手动旋后 - 前抽屉应力位X线片，以评估旋转不稳定的严重程度，并确定其临床相关性。
66例合并前距腓韧带（ATFL）和跟腓韧带（CFL）损伤的患者接受了三次双侧手动应力位X线片检查，采用该技术测量患侧踝关节相对于正常对侧踝关节的距骨前移（毫米）、距骨倾斜（°）和距骨旋转（%）的平均增量。评估每项测量的观察者内和观察者间可靠性，并根据是否存在额外的颈韧带不足比较增量程度的差异。
踝关节应力位X线片的观察者内和观察者间一致性分别为：距骨旋转（%）的ICC = 0.91和0.82，距骨前移的ICC = 0.64和0.51，距骨倾斜角的ICC = 0.78和0.71。在第2组中，包括合并ATFL和CFL损伤以及额外颈韧带不足的患者，与颈韧带完整的另一组（第1组）相比，观察到距骨旋转的增量显著更高，平均为6.4%（标准差3.4%），而距骨旋转平均为4.1%（标准差2.7）（p < 0.001）。
本研究中提出的一种用于诊断慢性外侧踝关节不稳定的新的综合应力位X线片技术，可能是一种可靠且具有代表性的测量工具，用于评估距下关节的额外损伤或不稳定。
前瞻性队列研究，二级。
