Persaud Sham, Hentges Matthew J, Catanzariti Alan R
Resident, Division of Foot & Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
Faculty, Division of Foot & Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
J Foot Ankle Surg. 2019 Mar;58(2):243-247. doi: 10.1053/j.jfas.2018.08.030. Epub 2018 Dec 21.
Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.
与2至3期成人获得性平足相关的后足外侧疼痛通常归因于腓骨下撞击。术前一般会进行磁共振成像（MRI），以评估胫后肌腱内的退变程度、内侧软组织限制的减弱以及后足和/或踝关节的退变情况。本研究的目的是确定与2期和3期成人获得性平足相关的外侧副韧带疾病/损伤的发生率。通过可搜索的计算机化医院数据库在2015年至2017年期间确定研究对象。通过病历审查和MRI分析确认患者存在2期或3期成人获得性平足畸形。根据医院放射科医生的患者MRI结果确认外侧踝关节韧带损伤，并记录在患者病历中。纳入标准要求患者被诊断为约翰逊和斯特罗姆2期或3期平足畸形且有记录的外侧踝关节疼痛，并且有放射科医生报告的术前MRI扫描结果。患者排除标准包括年龄<18岁的患者、由既往创伤、跗骨联合、神经性关节炎引起平足畸形的患者、既往有手术史的患者或病历不完整的患者。总共确定了118例符合这些参数的患者。在这118例患者中，74例（62.7%）在MRI上有外侧踝关节韧带损伤的记录。在77例2期成人获得性平足患者中，55例（71.4%）在MRI上确认有外侧踝关节韧带损伤。在41例3期成人获得性平足患者中，19例（46.3%）在MRI上确认有外侧踝关节韧带损伤。本研究表明，与成人获得性平足畸形相关的外侧韧带疾病发生率相对较高。这些发现可能对成人获得性平足手术治疗后的踝关节关节炎有长期影响。
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