Yasui Youichi, Murawski Christopher D, Wollstein Adi, Takao Masato, Kennedy John G
Hospital for Special Surgery, New York, NY.
Teikyo University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan.
JBJS Rev. 2016 May 31;4(5). doi: 10.2106/JBJS.RVW.15.00074.
Chronic lateral ankle instability can occur in a subset of patients following ankle inversion sprains. Operative treatment to restore stability in the ankle and hindfoot and to prevent further degenerative changes may be indicated in cases in which nonoperative treatment has failed. Anatomical direct repair with use of native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. The procedure has shown promising short and long-term outcomes. Candidates for the procedure have ligament remnants of sufficient quality that are amendable to direct repair. Anatomical reconstruction with use of autograft or allograft is reserved for patients with insufficient ligament remnants to fashion a direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. A wide variety of autografts have been described, each with potential advantages and disadvantages. These procedures can provide good-to-excellent short-term outcomes. However, there is no available information on their long-term clinical results. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneal brevis tendon and has been applied in cases in which only poor-quality ligament remains. The procedure can provide good to excellent short-term outcomes, although reported long-term outcomes have differed among studies. The particular tendon used for the graft should be carefully considered given the potential alterations in the kinematics of the ankle and hindfoot. Arthroscopic ligament repair is becoming increasingly popular as it is minimally invasive. This procedure is restricted to patients who have good-quality ligament remnants. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, although a relatively high rate of complications-including nerve damage-has been reported following the procedure and therefore warrants further investigation before widespread adoption can be advocated.
慢性外侧踝关节不稳可发生于部分踝关节内翻扭伤后的患者。对于非手术治疗失败的病例，可能需要进行手术治疗以恢复踝关节和后足的稳定性，并预防进一步的退行性改变。使用天然韧带残端进行解剖学直接修复，无论是否加强下支持带，是治疗外侧踝关节不稳的所谓金标准手术策略。该手术已显示出良好的短期和长期效果。该手术的候选者具有质量足够好且适合直接修复的韧带残端。对于韧带残端不足以进行直接修复、既往外侧踝关节修复失败、体重指数高或存在全身性韧带松弛的患者，则采用自体移植物或同种异体移植物进行解剖学重建。已经描述了多种自体移植物，每种都有其潜在的优缺点。这些手术可以提供良好至极佳的短期效果。然而，目前尚无关于其长期临床结果的可用信息。非解剖学外侧韧带重建通常涉及使用相邻的腓骨短肌腱，已应用于仅残留质量差的韧带的病例。该手术可以提供良好至极佳的短期效果，尽管不同研究报告的长期效果有所不同。考虑到踝关节和后足运动学的潜在改变，应仔细考虑用于移植物的特定肌腱。关节镜下韧带修复因其微创性而越来越受欢迎。该手术仅限于韧带残端质量良好的患者。短期和长期随访后均报告了良好至极佳的临床效果，尽管该手术后报告的并发症发生率相对较高，包括神经损伤，因此在广泛应用之前需要进一步研究。
