Nery Caio, Fonseca Lucas, Raduan Fernando, Moreno Marcus, Baumfeld Daniel
UNIFESP - Escola Paulista de Medicina, São Paulo, SP, Brazil.
UNIFESP - Escola Paulista de Medicina, São Paulo, SP, Brazil.
Foot Ankle Surg. 2018 Aug;24(4):320-325. doi: 10.1016/j.fas.2017.03.002. Epub 2017 Mar 22.
Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique.
Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery.
After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved spontaneously.
Despite the limited cohort and the relatively short follow-up period, the use of the "inside-out" arthroscopic technique may be considered as a valid option for the treatment of chronic ankle instability.
外侧踝关节韧带损伤是最常见的骨科损伤之一。本研究的目的是展示使用全关节镜下 Broström-Gould 技术的“由内向外”变体进行治疗的初步前瞻性结果。
纳入 26 例患者，其中男性 20 例，女性 6 例，年龄 19 - 60 岁，平均 41 岁。所有患者的“前抽屉试验”和“距骨倾斜试验”均为阳性。必要时，软骨损伤采用微骨折术治疗，前撞击症采用关节镜下切除术治疗；3 例患者有后足内翻，行 Dwyer 截骨术；1 例患者有腓骨肌腱病，采用关节镜下清创术治疗，另 1 例患者三角韧带部分损伤，采用直接修复治疗。使用两个关节镜手术入路，即前内侧和前外侧入路。仔细检查关节后，清理腓骨前表面以切除距腓前韧带的残余部分。在距外踝尖 1cm 处的腓骨前侧放置一个带两根缝线的锚钉。使用特殊的弯针将缝线穿过距腓前韧带的残余部分以及伸肌支持带。在踝关节保持中立位时，使用 Duncan 结将韧带和下伸肌支持带打结。患者非负重固定 2 周，然后在可拆除的保护靴中开始负重 4 周。患者术后 6 个月能够恢复体育活动。
平均随访 27 个月（范围 21 - 36 个月）后，使用美国矫形足踝协会（AOFAS）踝关节评分对患者进行功能评估。术前平均评分为 58 分，术后平均评分增至 90 分。1 例患者在腓浅神经区域出现感觉异常，后自行缓解。
尽管队列有限且随访期相对较短，但“由内向外”关节镜技术可被视为治疗慢性踝关节不稳的一种有效选择。
