Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.
Arch Orthop Trauma Surg. 2021 Jun;141(6):987-995. doi: 10.1007/s00402-021-03771-w. Epub 2021 Jan 17.
This study aimed to compare the clinical outcomes and postoperative activities of arthroscopic ankle lateral ligament (ALL) repair alone with arthroscopic ALL repair and reinforcement by the inferior extensor retinaculum (IER) for chronic ankle instability (CAI).
All patients who underwent arthroscopic repair for CAI between 2017 and 2019 were evaluated. The Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q), and duration between the surgery and walking without any support, jogging, and complete return to sports were evaluated and compared. The exclusion criteria were (1) follow-up period of < 1 year after surgery, (2) the presence of associated ankle lesions requiring treatment during the same operative procedure, including patients with subfibular ossicle bigger than 5 mm on radiographs, chondral or osteochondral defect, bony impingement, deltoid ligament tear, fibular tendon pathology, or posterior ankle impingement, and (3) patients who underwent revision surgery.
We identified 126 patients who underwent surgery for CAI and subsequently excluded 36 patients on account of a short follow-up period (< 1 year), additional surgery, and previous surgery. The remaining 90 eligible patients included arthroscopic ALL repair alone (group A, n = 44) and arthroscopic ALL repair with reinforcement by the inferior extensor retinaculum (group G, n = 46) groups. There was no significant difference in the postoperative activities nor in the preoperative or postoperative JSSF scale and SAFE-Q between the two groups. However, significant differences were seen in the mean surgical time (15.5 ± 8.1 vs 20.1 ± 7.6, P = 0.013).
This study showed no difference in clinical outcomes between the two groups. However, arthroscopic ALL repair with reinforcement by IER resulted in a longer surgical time than arthroscopic ALL repair alone.
Retrospective comparative study, level III.
本研究旨在比较单独行关节镜下踝关节外侧韧带（ALL）修复术与关节镜下 ALL 修复术联合伸肌下支持带（IER）加固术治疗慢性踝关节不稳定（CAI）的临床疗效和术后活动情况。
评估了 2017 年至 2019 年间行关节镜下 CAI 修复术的所有患者。采用日本足踝外科协会（JSSF）评分和自我管理足部评估问卷（SAFE-Q）评估并比较手术至无支撑行走、慢跑和完全恢复运动的时间。排除标准包括：（1）术后随访时间<1 年；（2）存在需要同期手术治疗的踝关节相关病变，包括影像学上腓骨下骨块大于 5mm、软骨或骨软骨损伤、骨撞击、距腓前韧带撕裂、腓骨肌腱病变或后踝撞击征；（3）行翻修手术的患者。
共纳入 126 例 CAI 患者，因随访时间短（<1 年）、再次手术和既往手术而排除 36 例，最终纳入 90 例符合条件的患者，其中行单纯关节镜下 ALL 修复术（A 组，n=44）和关节镜下 ALL 修复术联合 IER 加固术（G 组，n=46）。两组患者术后活动情况、术前和术后 JSSF 评分及 SAFE-Q 评分无显著差异。但两组患者的平均手术时间分别为（15.5±8.1）min 和（20.1±7.6）min，差异有统计学意义（P=0.013）。
本研究显示两组患者的临床疗效无差异，但 IER 加固的关节镜下 ALL 修复术比单纯关节镜下 ALL 修复术的手术时间更长。
回顾性比较研究，III 级。
