Nakasa Tomoyuki, Nakashiro Md PhD Jiro, Adachi Md PhD Nobuo
Surgeon, Department of Orthopaedic Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan.
Surgeon, Department of Orthopaedic Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan.
J Foot Ankle Surg. 2019 Jan;58(1):156-160. doi: 10.1053/j.jfas.2018.05.016. Epub 2018 Sep 20.
Arthroscopic repair of the lateral ankle ligament using the anchor system has been increasingly reported. We treated a 39-year-old woman who suffered from pain and instability in her left ankle joint. She was diagnosed with chronic ankle instability and an osteochondral lesion of the talar dome. For this patient, arthroscopic repair of the anterior talofibular ligament (ATFL) was performed. Standard anteromedial and anterolateral portals were placed, and excision of the osteochondral fragment and microfracture were performed. Then, an accessory anterolateral (AAL) portal was placed. No. 2 nylon sutures were inserted into the ATFL remnant through the AAL portal. Two bone tunnels were created at the footprint of the fibula attachment toward the posterior edge of the lateral malleolus using a passing pin, and nylon sutures anchored in the ATFL were retrieved toward the posterior fibula. The foot was held in neutral position with eversion, and nylon sutures were tied at the posterior fibula. At 1 year after surgery, the Japanese Society for Surgery of the Foot scale was improved from the preoperative value of 48 points to a postoperative value of 100 points. Stress radiography showed no difference of talar tilt angle between the involved and noninvolved ankles. Joint position sense was also improved at 3 and 6 months after surgery. This arthroscopic repair of the ATFL using the pull-out technique enabled achievement of an improved clinical score and stability of the ankle and proprioception, and there was no concern about complications of the anchor system.
使用锚钉系统进行踝关节外侧韧带的关节镜修复的报道日益增多。我们治疗了一名39岁的女性，她左侧踝关节疼痛且不稳定。她被诊断为慢性踝关节不稳定和距骨穹窿骨软骨损伤。对于该患者，进行了关节镜下前距腓韧带（ATFL）修复术。放置标准的前内侧和前外侧入路，切除骨软骨碎片并进行微骨折处理。然后，放置一个辅助前外侧（AAL）入路。通过AAL入路将2号尼龙缝线插入ATFL残端。使用穿针在腓骨附着点向外侧踝关节后缘处制作两个骨隧道，将锚定在ATFL中的尼龙缝线拉向腓骨后方。足部保持中立位并外翻，在腓骨后方打结尼龙缝线。术后1年，日本足外科学会评分从术前的48分提高到术后的100分。应力位X线片显示患侧和未患侧踝关节的距骨倾斜角无差异。术后3个月和6个月时关节位置觉也有所改善。这种使用拉出技术的关节镜下ATFL修复术能够提高临床评分，改善踝关节稳定性和本体感觉，且无需担心锚钉系统的并发症。
