Xu He-Xing, Lee Keun-Bae
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea.
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
Am J Sports Med. 2016 Dec;44(12):3152-3157. doi: 10.1177/0363546516657816. Epub 2016 Aug 5.
Generalized joint laxity (GJL) has been considered a risk factor for late failure of ligament reconstruction in the knee; however, it is not known whether GJL is the cause of recurrent instability after the modified Broström procedure for chronic lateral ankle instability.
To compare the clinical results of the modified Broström procedure for chronic lateral ankle instability in patients with or without GJL.
Cohort study; Level of evidence, 3.
A total of 100 patients (100 ankles) who underwent the modified Broström procedure were divided into 2 groups, with or without GJL, according to the Beighton criteria. Age and body mass index were matched between the 2 groups. The mean follow-up duration was 43.3 months in the laxity group (44 ankles; Beighton score ≥5) and 42.9 months in the nonlaxity group (56 ankles).
The mean preoperative Karlsson and American Orthopaedic Foot and Ankle Society (AOFAS) scores were a respective 53.2 and 60.9 in the laxity group and 53.9 and 62.6 in the nonlaxity group, and these scores improved to 87.4 and 89.5, respectively, in the laxity group and to 94.1 and 94.8, respectively, in the nonlaxity group at final follow-up. The mean preoperative talar tilt angle and anterior talar translation were a respective 12.5° and 8.8 mm in the laxity group and 10.8° and 8.5 mm in the nonlaxity group, and these values improved to 7.3° and 6.0 mm, respectively, in the laxity group and to 5.2° and 5.0 mm, respectively, in the nonlaxity group at final follow-up. Failure rates were 11.4% (5 patients) in the laxity group and 1.8% (1 patient) in the nonlaxity group. Significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, talar tilt angle, anterior talar translation, and failure rate at final follow-up (P < .05).
Patients with GJL showed inferior outcomes and a higher failure rate compared with patients without GJL. Therefore, GJL appears to be a risk factor associated with recurrent instability after the modified Broström procedure.
全身性关节松弛（GJL）被认为是膝关节韧带重建术后晚期失败的一个危险因素；然而，对于慢性外侧踝关节不稳行改良布罗斯特伦手术（modified Broström procedure）后，GJL是否是反复出现不稳定的原因尚不清楚。
比较有或无GJL的患者行改良布罗斯特伦手术治疗慢性外侧踝关节不稳的临床结果。
队列研究；证据等级为3级。
根据贝顿标准（Beighton criteria），将100例行改良布罗斯特伦手术的患者（100个踝关节）分为有或无GJL的两组。两组患者的年龄和体重指数相匹配。松弛组（44个踝关节；贝顿评分≥5）的平均随访时间为43.3个月，非松弛组（56个踝关节）为42.9个月。
松弛组术前卡尔森（Karlsson）评分和美国足踝外科协会（AOFAS）评分分别为53.2分和60.9分，非松弛组分别为53.9分和62.6分；末次随访时，松弛组上述评分分别提高到87.4分和89.5分，非松弛组分别提高到94.1分和94.8分。松弛组术前距骨倾斜角和距骨前移分别为12.5°和8.8 mm，非松弛组分别为10.8°和8.5 mm；末次随访时，松弛组上述值分别改善到7.3°和6.0 mm，非松弛组分别改善到5.2°和5.0 mm。松弛组失败率为11.4%（共5例患者），非松弛组为1.8%（1例患者）。末次随访时，两组在卡尔森评分、AOFAS评分、距骨倾斜角、距骨前移和失败率方面存在显著差异（P < 0.05）。
与无GJL的患者相比，有GJL的患者预后较差且失败率较高。因此，GJL似乎是改良布罗斯特伦手术后反复出现不稳定的一个危险因素。
