From the Division of Sports Medicine, Department of Orthopedics, Duke Sport Science Institute, Duke University, Durham, NC (Lau and Amendola), the Department of Orthopaedics, University of Utah, Salt Lake City, UT (Barg), The Steadman Clinic and Steadman Philippon Research Institute, Vail, CO (Haytmanek), and the Kansas City Orthopaedic Institute, Leawood, KS (McCullough).
J Am Acad Orthop Surg. 2021 Jan 1;29(1):e5-e13. doi: 10.5435/JAAOS-D-20-00176.
Recent concepts are changing the management of ankle instability. These include concurrent medial and lateral instabilities, use of ankle arthroscopy, use of suture anchors, all-arthroscopic stabilization, synthetic augmentation, and early postoperative rehabilitation. Medial sided injuries occur in up to 72% of the lateral ankle sprains, and concomitant repair may provide greater stability. Suture anchors are equally as strong as transosseous tunnels, and the technique is simple, reproducible, and may decrease complications, but anchors do increase costs. Synthetic augmentation demonstrates greater strength than Broström alone in cadaver-based biomechanical testing. Although clinical studies of synthetic augmentation have demonstrated equivocal stability and pain compared with Broström alone, synthetic augmentation may expedite rehabilitation. All-arthroscopic ankle stabilization is gaining popularity with increasing publications. Early findings demonstrate comparable biomechanical and clinical data compared with open techniques. Early postoperative weight-bearing within 2 weeks seems to be safe and may shorten time to return to play. Surgeons may consider using these novel techniques in the management of lateral ankle instability.
近期的理念正在改变踝关节不稳定的治疗方法。这些理念包括同时存在内侧和外侧不稳定、踝关节镜检查的应用、缝线锚钉的使用、全关节镜下稳定、合成增强以及术后早期康复。在高达 72%的外侧踝关节扭伤中会出现内侧侧副韧带损伤，同时修复可能会提供更大的稳定性。缝线锚钉与经骨隧道一样牢固，而且该技术简单、可重复，可能会减少并发症，但锚钉会增加成本。在基于尸体的生物力学测试中，合成增强材料比单独的 Broström 技术具有更大的强度。尽管在临床研究中，与单独的 Broström 技术相比，合成增强材料在稳定性和疼痛方面的效果并不一致，但合成增强材料可能会加快康复进程。全关节镜下踝关节稳定术随着越来越多的出版物的发表而越来越受欢迎。早期研究结果表明，与开放式技术相比，其在生物力学和临床数据方面具有可比性。术后 2 周内早期负重似乎是安全的，并且可能会缩短重返运动的时间。外科医生可能会考虑在治疗外侧踝关节不稳定时使用这些新技术。
