Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Aspire Zone, Doha, Qatar.
Orthopedic Department Póvoa de Varzim, Vila do Conde Hospital Centre, Vila do Conde, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):253-261. doi: 10.1007/s00167-019-05626-9. Epub 2019 Jul 29.
To assess the impact on ankle stability after repairing the ATFL alone compared to repairing both the ATFL and CFL in a biomechanical cadaver model.
Ten matched pairs of intact, fresh frozen human cadaver ankles (normal) were mounted to a test machine in 20.0° plantar flexion and 15.0° of internal rotation. Each ankle was loaded to body weight and then tested from 0.0° to 20.0° of inversion. The data recorded were torque at 20.0° and stiffness, peak pressure and contact area in the ankle joint using a Tekscan sensor, rotation of the talus and calcaneus, and translation of the calcaneus using a three-dimensional motion capture system. Ankles then underwent sectioning of the ATFL and CFL (injured), retested, then randomly assigned to ATFL-only Broström repair or combined ATFL and CFL repair. Testing was repeated after repair then loaded in inversion to failure (LTF).
The stiffness of the ankle was not significantly increased compared to the injured condition by repairing the ATFL only (n.s.) or the ATFL/CFL (n.s.). The calcaneus had significantly more rotation than the injured condition in the ATFL-only repair (p = 0.037) but not in the ATFL/CFL repair (n.s.). The ATFL failed at 40.3% higher torque than the CFL, at 17.4 ± 7.0 N m and 12.4 ± 4.1 N m, respectively, and 62.0% more rotation, at 43.9 ± 5.6° and 27.1 ± 6.8°, respectively.
There was a greater increase in stiffness following combined ATFL/CFL repair compared to ATFL-only repair, although this did not reach statistical significance. The CFL fails before the ATFL, potentially indicating its vulnerability immediately following repair.
III, case-control therapeutic study.
在生物力学尸体模型中评估单独修复 ATFL 与同时修复 ATFL 和 CFL 对踝关节稳定性的影响。
10 对完整、新鲜冷冻的人尸体踝关节（正常）在 20.0°跖屈和 15.0°内旋下安装到测试机上。每个踝关节加载体重，然后从 0.0°测试到 20.0°内翻。使用 Tekscan 传感器记录踝关节的扭矩和刚度、峰值压力和接触面积，使用三维运动捕捉系统记录距骨和跟骨的旋转以及跟骨的平移。然后将踝关节的 ATFL 和 CFL 切断（受伤），重新测试，然后随机分配到 ATFL 仅 Broström 修复或 ATFL 和 CFL 联合修复。修复后再次进行测试，然后加载到内翻失败（LTF）。
仅修复 ATFL 与受伤状态相比，踝关节的刚度没有显著增加（n.s.）或 ATFL/CFL 联合修复（n.s.）。在 ATFL 仅修复中，跟骨的旋转明显大于受伤状态（p=0.037），但在 ATFL/CFL 修复中则没有（n.s.）。ATFL 在 40.3%更高的扭矩下失效，分别为 17.4±7.0 N·m 和 12.4±4.1 N·m，旋转角度为 62.0%更高，分别为 43.9±5.6°和 27.1±6.8°。
与仅修复 ATFL 相比，联合修复 ATFL/CFL 后刚度增加更大，但未达到统计学意义。CFL 在 ATFL 之前失效，这可能表明其在修复后立即变得脆弱。
III 级，病例对照治疗研究。
