Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.
Foot and Ankle Unit, iMove Tres Torres and Hospital Quirón, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):70-78. doi: 10.1007/s00167-019-05460-z. Epub 2019 Mar 19.
Tendon grafts are often utilized for reconstruction of the lateral ligaments unamenable to primary repair. However, tendon and ligaments have different biological roles. The anterior tibiofibular ligament's (ATiFL) distal fascicle may be resected without compromising the stability of the ankle joint. The aim of this study is to describe an all-arthroscopic and intra-articular surgical technique of ATiFL's distal fascicle transfer for the treatment of chronic ankle instability.
Five unpaired cadaver ankles underwent arthroscopic ATiFL's distal fascicle transfer using a non-absorbable suture and a knotless anchor. Injured or absent ATiFL's distal fascicle were excluded from the study. Following arthroscopy, the ankles were dissected and evaluated for entrapment of nearby adjacent anatomical structures. The ligament transfer was also assessed. The distance between the anterolateral (AL) portals and the superficial peroneal nerve (SPN) was measured and the shortest distance was reported.
All specimens revealed successful transfer of the tibial origin of the ATiFL's distal fascicle onto the talar insertion of anterior talofibular ligament's (ATFL) superior fascicle. The fibular origin of the ATiFL's distal fascicle remained intact. There were no specimens with SPN or extensor tendon entrapment. The median distance between the proximal AL portal and SPN was 3.8 mm. The median distance between the distal AL portal and SPN was 3.9 mm.
An all-arthroscopic approach to an ATiFL's distal fascicle transfer is a reliable method to reconstruct the ATFL's superior fascicle. Transfer of ATiFL's distal fascicle avoids the need for tendon harvest or allograft. The lack of injury to nearby adjacent structures suggests that it is a safe procedure. The clinical relevance of the study is that ATiFL's distal fascicle can be arthroscopically transferred to be used as a biological reinforcement of the ATFL repair, or as an ATFL reconstruction.
当外侧韧带无法进行初次修复时，通常会使用肌腱移植物进行重建。然而，肌腱和韧带具有不同的生物学作用。前胫腓骨韧带（ATiFL）的远端束可以被切除而不会影响踝关节的稳定性。本研究旨在描述一种全关节镜下和关节内的 ATiFL 远端束转移手术技术，用于治疗慢性踝关节不稳定。
5 个非配对的尸体踝关节接受了使用不可吸收缝线和无结锚的关节镜下 ATiFL 远端束转移。本研究排除了受伤或缺失的 ATiFL 远端束。关节镜检查后，对踝关节进行解剖并评估附近相邻解剖结构的嵌顿情况。还评估了韧带转移。测量了前外侧（AL）门和浅表腓神经（SPN）之间的距离，并报告最短距离。
所有标本均成功地将 ATiFL 的远端束的胫骨起点转移到前距腓骨韧带（ATFL）上束的距骨插入处。ATiFL 的远端束的腓骨起点保持完整。没有 SPN 或伸肌腱嵌顿的标本。近端 AL 门和 SPN 之间的中位数距离为 3.8 毫米。远端 AL 门和 SPN 之间的中位数距离为 3.9 毫米。
ATiFL 远端束的全关节镜方法是重建 ATFL 上束的可靠方法。ATiFL 远端束的转移避免了肌腱采集或同种异体移植物的需要。附近相邻结构无损伤表明这是一种安全的手术。本研究的临床意义在于，ATiFL 的远端束可以通过关节镜转移，用作 ATFL 修复的生物增强物，或作为 ATFL 重建。
