Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Cascais, Portugal.
Department of Orthopaedic Surgery, Hospital da Cruz Vermelha, Lisbon, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3512-3524. doi: 10.1007/s00167-021-06610-y. Epub 2021 May 15.
Despite being a significant public health problem, ankle sprains' prognostic factors are largely unknown. This review aimed to systematically analyze the literature on acute ankle sprains to compare the prognosis of a combined anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments rupture with an isolated ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes.
The databases for Pubmed, CENTRAL and Web of Science were searched. Clinical studies reporting the prognostic effect of combined ATFL-CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow-up of 12 months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included. The relative risk (RR), along with the 95% confidence interval (CI), was used to quantitatively analyze the main outcomes.
Nine papers were selected for inclusion, of which five were suitable for quantitative analysis. None of them found a statistically significant correlation between ligament injury severity and progression to chronic instability. Concerning other clinical outcomes, three studies found a statistically significant correlation between a combined ligament injury and a worse clinical prognosis. From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no significant difference.
A significant statistical correlation between a combined ATFL-CFL rupture and chronic ankle instability, compared to an isolated ATFL rupture, was not found. There is, however, fair evidence showing a worse clinical outcome score in the combined ruptures, as well as a decreased return to full sports activities. The use of reliable and accessible diagnostic methods to determine the number of ruptured ligaments might have a role in managing severe ankle sprains.
Level III.
尽管踝关节扭伤是一个重大的公共卫生问题，但人们对其预后因素仍知之甚少。本综述旨在系统分析急性踝关节扭伤的文献，比较联合距腓前韧带（ATFL）和跟腓韧带（CFL）撕裂与单独 ATFL 撕裂在慢性踝关节不稳定和其他临床结局方面的预后。
检索 Pubmed、CENTRAL 和 Web of Science 数据库。纳入符合以下标准的临床研究：报告了保守治疗的踝关节扭伤中联合 ATFL-CFL 撕裂与单独 ATFL 撕裂的预后影响，随访时间至少 12 个月，并且使用可靠的前外侧踝关节韧带评估方法（即超声、磁共振成像、关节造影或应变成像术）进行诊断。使用相对风险（RR）及其 95%置信区间（CI）定量分析主要结局。
共纳入 9 篇文献，其中 5 篇适合进行定量分析。没有研究发现韧带损伤严重程度与慢性不稳定进展之间存在统计学显著相关性。关于其他临床结局，有 3 项研究发现联合韧带损伤与更差的临床预后之间存在统计学显著相关性。从定量分析结果来看，单一韧带撕裂与联合韧带撕裂后慢性踝关节不稳定的相对风险（RR）无显著差异。
没有发现联合 ATFL-CFL 撕裂与慢性踝关节不稳定之间存在显著的统计学相关性，与单独 ATFL 撕裂相比。然而，有相当多的证据表明联合撕裂的临床结局评分更差，且完全恢复运动活动的可能性更小。使用可靠且易于获取的诊断方法来确定撕裂的韧带数量可能在管理严重的踝关节扭伤方面具有一定作用。
III 级。
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