Shakked Rachel J, Karnovsky Sydney, Drakos Mark C
Rothman Institute, 3300 Tillman Drive, 2nd Floor, Bensalem, Philadelphia, PA, 19020-2071, USA.
Hospital for Special Surgery, New York, NY, USA.
Curr Rev Musculoskelet Med. 2017 Mar;10(1):113-121. doi: 10.1007/s12178-017-9391-x.
Ankle sprains, which account for 40% of sports injuries in the USA, can lead to chronic ankle instability. Chronic ankle instability can be classified as functional, mechanical, or a combination of both and is diagnosed using a combination of a physical exam, an MRI, and stress radiographs. This review focuses on different approaches to treatment, including non-operative and operative techniques, of chronic ankle instability, including reviewing traditional procedures as well as more novel and newer techniques.
Based on existing literature, non-operative treatment should always precede operative treatment of chronic ankle instability. If rehabilitation fails, Brostrom-Gould type ankle stabilization has been the preferred surgical option. Recent literature suggests that arthroscopic repair might reduce recovery time and improve outcomes in certain populations; however, there are higher rates of complication following these surgeries. In more high-risk populations, some literature reports that ligament repair with peroneus brevis transfer could be a more effective treatment option. Currently, varying surgical techniques exist for the treatment of chronic ankle instability. While the more recently reported techniques show promise, it is important to note that there is little evidence showing they are more successful than traditional techniques. It is imperative that future studies focus on outcomes and complication rates of these newer procedures.
在美国,踝关节扭伤占运动损伤的40%,可导致慢性踝关节不稳。慢性踝关节不稳可分为功能性、机械性或两者兼有的类型,通过体格检查、磁共振成像(MRI)和应力位X线片相结合的方法进行诊断。本综述重点关注慢性踝关节不稳的不同治疗方法,包括非手术和手术技术,涵盖传统手术以及更新颖的技术。
基于现有文献,慢性踝关节不稳的手术治疗前应始终先进行非手术治疗。如果康复治疗失败,Brostrom-Gould型踝关节稳定术一直是首选的手术方式。近期文献表明,关节镜修复术可能会缩短某些人群的恢复时间并改善治疗效果;然而,这些手术的并发症发生率较高。在一些高危人群中,一些文献报道,短肌转移韧带修复术可能是一种更有效的治疗选择。目前,治疗慢性踝关节不稳存在多种手术技术。虽然最近报道的技术显示出前景,但需要注意的是,几乎没有证据表明它们比传统技术更成功。未来的研究必须聚焦于这些新手术的治疗效果和并发症发生率。