Hunt Kenneth J, Griffith Rebecca
Department of Orthopedic Surgery, University of Colorado, Aurora, USA.
Curr Rev Musculoskelet Med. 2020 Dec;13(6):788-796. doi: 10.1007/s12178-020-09679-z. Epub 2020 Nov 7.
Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment.
Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.
外侧踝关节韧带扭伤是高水平运动员和普通人群中最常报告的损伤之一。不幸的是，其中高达40%的损伤可能会发展为慢性外侧踝关节不稳定，在适当情况下需要手术干预。本综述的目的是介绍慢性外侧不稳定的解剖学韧带修复金标准手术治疗方法，并强调手术治疗时的技术、结果及解剖学的重要性。
近期和既往文献均认为慢性踝关节不稳定的初始治疗是非手术康复。在康复失败的病例中，手术治疗的金标准是采用Brostrom-Gould技术进行开放解剖修复，随着时间推移，该技术效果显著。近期研究表明，关节镜检查和内置支撑装置的效果同样良好，且两种技术都具有早期康复的潜力。对于存在解剖修复禁忌证的患者，包括先天性软组织松弛、高体重指数以及翻修手术情况，解剖学韧带重建是合适的手术选择。开放改良Brostrom外侧韧带修复仍然是慢性外侧韧带不稳定手术治疗的首选方法。在新的改良方法和技术出现的情况下，需要进行长期结果研究，以确定它们的长期效用，并将其与开放手术结果进行比较。标准化康复方案以及恢复运动指标将有助于更好地评估未来的结果。
