Canton Stephen, Anderst William, Hogan MaCalus V
The University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
Curr Rev Musculoskelet Med. 2020 Feb;13(1):77-85. doi: 10.1007/s12178-020-09601-7.
Lateral ligament repair, specifically the modified Broström-Gould (BG) procedure, has been described for patients with chronic ankle instability (CAI) after failure of nonoperative management. However, there is minimal data about native in vivo ankle bone kinematics and how repairs such as the BG procedure affect the kinematics. The objective of this review is to appraise existing literature that used biplane radiography to measure in vivo kinematics of the ankle in healthy, CAI, and BG populations.
Results showed that the tibiotalar joint contributes more to dorsi/plantarflexion, the subtalar joint contributes more to inversion/eversion and internal/external rotation, and that both joints are capable of complex three-dimensional (3D) motion. Preliminary data suggests that demanding activities (as opposed to walking) are necessary to elicit kinematic differences between healthy and CAI populations. Results also indicate that the BG procedure restores static kinematics and range of motion. All but one of the studies identified in this review collected static, quasi-stance, or partial gait capture data. The strength of our current knowledge is low given the small sample sizes, exploratory nature of previous work, and lack of rigorous experimental design in previous studies. Future directions include development of an improved protocol for establishing coordinate systems in the ankle bones, continued development of a database of normal kinematics during a variety of activities, and large-scale, longitudinal studies of CAI and BG patients.
对于非手术治疗失败的慢性踝关节不稳（CAI）患者，已有人描述了外侧韧带修复术，特别是改良的布罗斯特伦-古尔德（BG）手术。然而，关于踝关节在体骨骼运动学以及BG手术等修复方式如何影响运动学的数据极少。本综述的目的是评估现有文献，这些文献使用双平面X线摄影测量健康人群、CAI患者和接受BG手术人群的踝关节在体运动学。
结果显示，胫距关节在背屈/跖屈中贡献更大，距下关节在内翻/外翻以及内旋/外旋中贡献更大，并且两个关节都能够进行复杂的三维（3D）运动。初步数据表明，需要进行高要求活动（与步行相对）才能揭示健康人群和CAI患者之间的运动学差异。结果还表明，BG手术可恢复静态运动学和活动范围。本综述中确定的研究除一项外，均收集了静态、准站立或部分步态捕捉数据。鉴于样本量小、先前研究的探索性质以及先前研究缺乏严格的实验设计，我们目前的知识水平较低。未来的方向包括制定一种改进的方案来建立踝关节骨骼中的坐标系，继续开发各种活动期间正常运动学的数据库，以及对CAI患者和接受BG手术患者进行大规模的纵向研究。
