Gautschi Martina, Bachmann Elias, Shirota Camila, Götschi Tobias, Renner Niklas, Wirth Stephan H
Balgrist University Hospital, Zürich, Switzerland.
Laboratory for Orthopedic Biomechanics, ETH Zürich, Zürich, Switzerland.
Orthop J Sports Med. 2020 Oct 22;8(10):2325967120959284. doi: 10.1177/2325967120959284. eCollection 2020 Oct.
Anatomic lateral ankle ligament reconstruction has been proposed for patients with chronic ankle instability. A reliable approach is a reconstruction technique using an allograft and 2 fibular tunnels. A recently introduced approach that entails 1-fibular tunnel reconstruction might reduce the risk of intraoperative complications and ultimately improve patient outcome.
We hypothesized that both reconstruction techniques show similar ankle stability (joint laxity and stiffness) and are similar to the intact joint condition.
Controlled laboratory study.
A total of 10 Thiel-conserved cadaveric ankles were divided into 2 groups and tested in 3 stages-intact, transected, and reconstructed lateral ankle ligaments-using either the 1- or the 2-fibular tunnel technique. To quantify stability in each stage, anterior drawer and talar tilt tests were performed in 0°, 10°, and 20° of plantarflexion (anterior drawer test) or dorsiflexion (talar tilt test). Bone displacements were measured using motion capture, from which laxity and stiffness were calculated together with applied forces. Finally, reconstructed ligaments were tested to failure in neutral position with a maximal applicable torque in inversion. A mixed linear model was used to describe and compare the outcomes.
When ankle stability of intact and reconstructed ligaments was compared, no significant difference was found between reconstruction techniques for any flexion angle. Also, no significant difference was found when the maximal applicable torque of the 1-tunnel technique (9.1 ± 4.4 N·m) was compared with the 2-tunnel technique (8.9 ± 4.8 N·m).
Lateral ankle ligament reconstruction with an allograft using 1 fibular tunnel demonstrated similar biomechanical stability to the 2-tunnel approach.
Demonstrating similar stability in a cadaveric study and given the potential to reduce intraoperative complications, the 1-fibular tunnel approach should be considered a viable option for the surgical therapy of chronic ankle instability. Clinical randomized prospective trials are needed to determine the clinical outcome of the 1-tunnel approach.
对于慢性踝关节不稳患者，已有人提出进行解剖学外侧踝关节韧带重建。一种可靠的方法是使用同种异体移植物和两个腓骨隧道的重建技术。最近引入的一种采用单腓骨隧道重建的方法可能会降低术中并发症的风险，并最终改善患者的预后。
我们假设两种重建技术均显示出相似的踝关节稳定性（关节松弛度和僵硬度），且与完整关节状况相似。
对照实验室研究。
将总共10个经蒂尔固定保存的尸体踝关节分为两组，并分三个阶段进行测试——完整、横断和重建外侧踝关节韧带，分别采用单腓骨隧道或双腓骨隧道技术。为了量化每个阶段的稳定性，在跖屈0°、10°和20°（前抽屉试验）或背屈（距骨倾斜试验）时进行前抽屉试验和距骨倾斜试验。使用运动捕捉测量骨位移，并据此计算松弛度、僵硬度以及施加的力。最后，在中立位对重建韧带施加最大适用内翻扭矩直至失效进行测试。使用混合线性模型来描述和比较结果。
当比较完整韧带和重建韧带的踝关节稳定性时，在任何屈曲角度下，两种重建技术之间均未发现显著差异。此外，将单隧道技术的最大适用扭矩（9.1±4.4 N·m）与双隧道技术（8.9±4.8 N·m）进行比较时，也未发现显著差异。
使用单腓骨隧道同种异体移植物重建外侧踝关节韧带与双隧道方法具有相似的生物力学稳定性。
在尸体研究中显示出相似的稳定性，且有可能减少术中并发症，单腓骨隧道方法应被视为慢性踝关节不稳手术治疗的可行选择。需要进行临床随机前瞻性试验来确定单隧道方法的临床疗效。
