Choisne Julie, Hoch Matthew C, Alexander Ian, Ringleb Stacie I
1 Department of Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA.
2 School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA, USA.
Foot Ankle Int. 2017 Mar;38(3):324-330. doi: 10.1177/1071100716674997. Epub 2016 Nov 14.
Subtalar instability is associated with up to 80% of patients presenting with chronic ankle instability but is often not considered in the diagnosis or treatment. Operative procedures to repair ankle instability have shown good clinical results, but the effects of these reconstruction procedures on isolated subtalar instability are not well understood. The goal of this study was to investigate the effect of the Gould modification of the Broström procedure and a new tenodesis reconstruction procedure on ankle and subtalar joint kinematics after simulating a subtalar injury.
Kinematic data were collected on 7 cadaveric ankles during inversion through the range of ankle flexion and during internal rotation. Testing was performed on the intact foot; after sectioning the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament; after the Gould modification of the Broström procedure was performed; and after tenodesis was performed and sutures from the Gould modification removed.
The Gould modification of the Broström procedure significantly decreased subtalar and ankle inversion motion and subtalar internal rotation compared to the unstable condition. The tenodesis method restricted internal rotation at the subtalar joint and ankle inversion compared to the intact state.
Both operative procedures improved stability of the ankle complex, but tenodesis was unable to restore subtalar inversion and restricted ankle inversion in maximum plantarflexion.
The Gould modification of Broström ligament repair may be a favorable operative procedure for the restoration of subtalar and ankle joint kinematics.
距下关节不稳与高达80%的慢性踝关节不稳患者相关，但在诊断或治疗中常未被考虑。修复踝关节不稳的手术操作已显示出良好的临床效果，但这些重建手术对孤立性距下关节不稳的影响尚不清楚。本研究的目的是在模拟距下关节损伤后，研究Gould改良的Broström手术和一种新的腱固定重建手术对踝关节和距下关节运动学的影响。
在7具尸体踝关节上，通过踝关节屈伸范围和内旋过程收集运动学数据。测试在完整足上进行；切断跟腓韧带、颈韧带和距跟骨间韧带后进行测试；进行Gould改良的Broström手术后进行测试；进行腱固定手术并移除Gould改良手术的缝线后进行测试。
与不稳定状态相比，Gould改良的Broström手术显著降低了距下关节和踝关节的内翻运动以及距下关节的内旋。与完整状态相比，腱固定方法限制了距下关节的内旋和踝关节的内翻。
两种手术操作均改善了踝关节复合体的稳定性，但腱固定无法恢复距下关节的内翻，且在最大跖屈时限制了踝关节的内翻。
Gould改良的Broström韧带修复术可能是恢复距下关节和踝关节运动学的一种有利手术方法。
