Nakasa Tomoyuki, Ikuta Yasunari, Ota Yuki, Kanemitsu Munekazu, Sumii Junichi, Nekomoto Akinori, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan; Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
J Orthop Sci. 2021 Jan;26(1):156-161. doi: 10.1016/j.jos.2020.02.011. Epub 2020 Mar 20.
Lateral ankle ligament repair for chronic lateral ankle instability is common, and arthroscopic repair of the anterior talofibular ligament (ATFL) has been widely performed. However, it is desirable to repair of calcaneofibular ligament (CFL) combined with arthroscopic ATFL repair to obtain good long term clinical outcomes. Repairing CFL through small skin incision, there is the possibility to interfere with ATFL and CFL anchors because of close attachment of ATFL and CFL at fibula. The purpose of this study is to determine the safety anchor insertion angles for ATFL and CFL on CT images and to achieve ATFL and CFL repair with minimally invasive technique.
Fifty ankles in 50 patients were included in this study. On a sagittal CT image, the anchor drill hole angles for ATFL and CFL were measured to avoid interference with these anchors. Then, arthroscopic ATFL repair combined with CFL repair was performed on 15 patients according to the safety insertion angles obtained by CT. CFL repair was performed through 1.5 cm length of accessory anterolateral portal. Clinical outcome was evaluated using the Japanese Society for the Surgery of the Foot (JSSF) ankle hindfoot scale and the Karlsson score before surgery and at final follow-up.
On the CT image, the mean angles between the ATFL drill hole and anterior border of the fibula was 59.4 ± 6.5°, and those between the longitudinal axis of the fibula and ATFL drill hole, and the CFL drill hole were 34.6 ± 5.0°, and 15.1 ± 5.7°, respectively. Postoperative CT after arthroscopic ATFL repair combined with CFL repair showed that no interference with 2 anchors, and JSSF scale and the Karlsson score were significantly improved from preoperative to final follow-up.
This study showed how safety ATFL and CFL anchor insertion angles comprise a minimally invasive anatomical repair technique.
慢性外侧踝关节不稳的外侧韧带修复很常见，关节镜下修复距腓前韧带（ATFL）已被广泛开展。然而，为获得良好的长期临床效果，联合关节镜下ATFL修复同时修复跟腓韧带（CFL）是很有必要的。通过小切口修复CFL时，由于ATFL和CFL在腓骨处附着紧密，存在干扰ATFL和CFL锚钉的可能性。本研究的目的是在CT图像上确定ATFL和CFL安全的锚钉置入角度，并采用微创技术实现ATFL和CFL的修复。
本研究纳入50例患者的50个踝关节。在矢状位CT图像上测量ATFL和CFL的锚钉钻孔角度，以避免锚钉相互干扰。然后，根据CT获得的安全置入角度，对15例患者进行关节镜下ATFL修复联合CFL修复。通过1.5 cm长的辅助前外侧入路进行CFL修复。采用日本足外科学会（JSSF）踝关节后足评分和卡尔森评分在术前及末次随访时评估临床疗效。
在CT图像上，ATFL钻孔与腓骨前缘的平均角度为59.4±6.5°，腓骨纵轴与ATFL钻孔、CFL钻孔的平均角度分别为34.6±5.0°和15.1±5.7°。关节镜下ATFL修复联合CFL修复术后CT显示未出现两个锚钉相互干扰的情况，JSSF评分和卡尔森评分从术前到末次随访均显著改善。
本研究表明了ATFL和CFL安全的锚钉置入角度构成了一种微创解剖修复技术。
