Tourné Y, Mabit C
Centre ostéo-articulaire des Cèdres, 5, rue des Tropiques, Parc Galaxie-Sud, 38130 Échirolles, France.
Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Laboratoire d'anatomie, faculté de médecine, 2, rue Dr-Marcland, 87025 Limoges, France.
Orthop Traumatol Surg Res. 2017 Feb;103(1S):S171-S181. doi: 10.1016/j.otsr.2016.06.026. Epub 2016 Nov 18.
Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported.
踝关节外侧间室的关节囊/韧带损伤会导致外侧松弛，这是慢性踝关节不稳的主要原因。外侧韧带重建可稳定关节。详尽的术前临床和辅助检查至关重要。本文从长期稳定和降低骨关节炎风险的角度对主要技术进行了分类、介绍和批评。带加强（主要是伸肌支持带）的解剖学韧带修复或解剖学韧带重建是两种推荐的选择。使用腓骨短肌的非解剖学重建应被摒弃。关节镜检查正日益发展，但结果需要比目前更长时间的随访评估。术后神经肌肉重新编程对于最佳恢复至关重要。最后，从诊断和治疗的角度讨论了复杂踝关节不稳的概念。报告了各种韧带重建失败的形式及相应治疗方法。
