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 Traumatología Clínica Tres Torres, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):116-123. doi: 10.1007/s00167-019-05676-z. Epub 2019 Aug 20.
Chronic ankle instability has been described as presenting with complete tears of both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in 20% of cases. Arthroscopic techniques to treat chronic ankle instability are increasingly being reported and in some instances they can be technically demanding. The aim of this study was to describe an arthroscopic all-inside repair of both the ATFL and CFL, and to report the outcomes of a group of patients with chronic ankle instability that underwent the technique.
Twenty-four patients [22 male and 2 female, median age 41 (range 22-56) years] with chronic ankle instability and torn ATFL and CFL were treated arthroscopically after failing non-operative management. Median follow-up was 35 (mean 34.7, and range 18-55) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, both fascicles of the ATFL and the CFL were repaired.
Arthroscopic examination demonstrated ATFL and CFL injuries in all patients. Subjective improvement in their ankle instability was observed postoperatively. The anterior drawer and the talar tilt tests were negative at follow-up. The median AOFAS score increased from 65 (mean 65, range 52-85) preoperatively to 97 (mean 97, range 85-100) at final follow-up.
Chronic ankle instability with concomitant injury of both the ATFL and CFL, can be successfully treated by an arthroscopic all-inside repair. The clinical relevance of the study is the description of the first arthroscopic all-inside ATFL and CFL anatomic repair technique, which offers excellent clinical results and the inherent benefits from minimally invasive surgery.
IV, retrospective case series.
慢性踝关节不稳定被描述为在 20%的病例中同时出现前距腓韧带（ATFL）和跟腓韧带（CFL）完全撕裂。关节镜技术治疗慢性踝关节不稳定的方法越来越多，在某些情况下，这些技术可能具有很高的技术要求。本研究的目的是描述一种同时修复 ATFL 和 CFL 的关节镜下全内修复技术，并报告一组接受该技术治疗的慢性踝关节不稳定患者的结果。
24 例 [22 例男性和 2 例女性，中位年龄 41 岁（范围 22-56 岁）] 慢性踝关节不稳定且 ATFL 和 CFL 撕裂患者在非手术治疗失败后接受关节镜治疗。中位随访时间为 35 个月（平均 34.7 个月，范围 18-55 个月）。通过关节镜下全内技术，使用缝线传递器和两个无结锚钉，修复 ATFL 和 CFL 的两个束。
所有患者的关节镜检查均显示 ATFL 和 CFL 损伤。术后观察到踝关节不稳定的主观改善。前抽屉试验和距骨倾斜试验在随访时均为阴性。AOFAS 评分中位数从术前的 65 分（平均 65 分，范围 52-85 分）增加到最终随访时的 97 分（平均 97 分，范围 85-100 分）。
同时伴有 ATFL 和 CFL 损伤的慢性踝关节不稳定可以通过关节镜下全内修复成功治疗。本研究的临床意义在于描述了首例关节镜下 ATFL 和 CFL 解剖修复技术，该技术提供了出色的临床结果，并具有微创外科的固有优势。
IV，回顾性病例系列。
