Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France; Department of Radiology, Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France.
Diagn Interv Imaging. 2019 Feb;100(2):117-125. doi: 10.1016/j.diii.2018.09.002. Epub 2018 Nov 13.
The purpose of this study was to describe the positioning of bone tunnels of arthroscopic anatomical reconstruction of lateral ankle ligaments (AAR-LAL) and identify radiological measurements associated with short-term clinical outcome one year after surgery.
A total of 61 patients were included in this IRB-approved retrospective study. There were 52 men and 9 women, with a mean age of 36.3 ± 10.8 (SD) years. AAR-LAL was performed to treat chronic instability secondary to strain sequelae after failure of conservative treatment. Good short-term clinical outcome was defined by Karlsson-score≥80 (n=40) one year after surgery. Sixteen radiological measurements were studied to characterize the positionings of fibular, talar and calcaneal tunnels (FT, TT and CT, respectively). Feasibility and inter-observer agreement were calculated for each measurement. Receiver operating characteristic curves were used to identify optimal thresholds for measurements associated with outcome at univariate analysis. A binary logistic regression was used to identify independent predictors.
Two measurements were associated with good outcome: distance from the proximal FT entrance to the distal end of the fibula on anteroposterior (AP) view (called 'AP distal FT', P=0.005), and the ratio between the distance from TT entrance to the talo-navicular joint and the talus length on lateral view (P=0.009). Optimal thresholds were of >35mm and<0.445, respectively. At multivariate anlysis, only 'AP distal FT'>35mm remained independent predictor of good outcome (P=0.002).
Radiological evaluation of bone tunnels following AAR-LAL is feasible, reproducible, and helps predict short-term outcome after reconstruction of lateral ankle ligaments.
本研究旨在描述关节镜下解剖重建外侧踝关节韧带（AAR-LAL）的骨隧道定位，并确定与术后 1 年短期临床结果相关的影像学测量值。
本研究共纳入 61 例患者，其中男性 52 例，女性 9 例，平均年龄 36.3±10.8（SD）岁。行 AAR-LAL 治疗因保守治疗失败后遗留的慢性踝关节不稳，且为慢性踝关节扭伤后遗症。术后 1 年Karlsson 评分为≥80 分定义为短期临床疗效良好（n=40）。共研究了 16 项影像学测量值，以描述腓骨、距骨和跟骨隧道（FT、TT 和 CT）的位置。计算了每个测量值的可行性和观察者间一致性。使用受试者工作特征曲线在单变量分析中识别与结果相关的测量值的最佳阈值。使用二元逻辑回归识别独立预测因子。
有两项测量值与良好的结果相关：前后位（AP）视图上从近端 FT 入口到腓骨远端的距离（称为“AP 远端 FT”，P=0.005），以及侧位视图上 TT 入口到距跟关节的距离与距骨长度的比值（P=0.009）。最佳阈值分别为>35mm 和<0.445。在多变量分析中，只有“AP 远端 FT”>35mm 是良好结果的独立预测因子（P=0.002）。
AAR-LAL 后骨隧道的影像学评估是可行的、可重复的，并有助于预测外侧踝关节韧带重建后的短期结果。
