Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Curr Pain Headache Rep. 2020 Feb 4;24(3):8. doi: 10.1007/s11916-020-0840-7.
Chronic ankle pain is a prevalent and significant cause of chronic pain. While the definition of chronic ankle pain is heterogeneous and poorly defined in the literature, systematic reviews and meta-analyses have estimated this condition to be a prevalent and debilitating source of chronic pain. The most identifiable and prominent cause of chronic ankle pain is chronic ankle instability (CAI), a condition defined by instability of the ankle-joint complex. It is a common consequence of lateral ankle sprains or ligamentous injuries and can be described as a failure of the lateral ankle joint complex after an acute, or recurring, ankle injury. The objective of this manuscript is to provide a comprehensive review of CAI diagnosis and our current understanding of minimally invasive treatment options.
First-line treatment is conservative management, some of which includes neuromuscular rehabilitation, balance training, nonsteroidal anti-inflammatory drugs (NSAIDs), manual mobilization, ice therapy, and compression. While conservative management is effective, additional treatments for those who fail conservative management, or who seek alternative options also have been explored. Recent advances and modern techniques have expanded available treatment options, many of which are becoming less invasive, and have shown improving functionality, recovery, and patient satisfaction. Minimally invasive treatments highlighted in this review include: arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies. This review will discuss some of these current treatments for minimally invasive treatment of CAI, as well as suggest novel treatments for clinical trials and further investigation.
慢性踝关节疼痛是一种普遍且严重的慢性疼痛原因。虽然慢性踝关节疼痛的定义在文献中存在异质性且定义不明确，但系统评价和荟萃分析估计，这种疾病是一种普遍且使人衰弱的慢性疼痛来源。慢性踝关节疼痛最明显和突出的原因是慢性踝关节不稳定（CAI），这是一种踝关节复合体不稳定的疾病。它是外侧踝关节扭伤或韧带损伤的常见后果，可以描述为急性或复发性踝关节损伤后外侧踝关节复合体的失效。本文的目的是全面综述 CAI 的诊断以及我们对微创治疗选择的现有认识。
一线治疗是保守治疗，其中一些包括神经肌肉康复、平衡训练、非甾体抗炎药（NSAIDs）、手动松动、冰疗和压缩。虽然保守治疗有效，但对于那些保守治疗失败或寻求替代方案的患者，也已经探索了其他治疗方法。最近的进展和现代技术扩大了可用的治疗选择，其中许多方法的侵入性较小，并且已经显示出改善的功能、恢复和患者满意度。本综述强调了一些微创治疗方法，包括：关节镜手术、类固醇注射、富血小板血浆注射、透明质酸（HA）注射、药用信号细胞注射、射频治疗和冲击波治疗。本综述将讨论这些目前用于 CAI 微创治疗的一些方法，并为临床试验和进一步研究提出新的治疗方法。
