University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Bone Joint Surg Am. 2021 Oct 20;103(20):1927-1936. doi: 10.2106/JBJS.20.01787.
Ligamentous ankle injuries are the most common injuries sustained by athletes and by the general population, with an incidence of approximately 2 million per year in the U.S. Injuries to the ankle syndesmosis (i.e., "high ankle sprains") are generally treated operatively. Although cadaveric studies can evaluate syndesmosis fixation strength, they cannot predict how healing, neuromuscular adaptation, or dynamic loading will affect in vivo biomechanics. Using dynamic biplane radiography (DBR), we tested the hypothesis that syndesmosis repair would restore ankle kinematics and ligament elongation during static and dynamic loading.
A convenience sample of 6 male patients who had undergone fixation (2 screw, 3 suspensory, 1 hybrid) of syndesmosis injury were assessed with use of DBR during forward running, backpedaling, a 45° angled single-leg hop, and 1 static standing trial at 2 to 4.5 years postoperatively. Three-dimensional ankle kinematics and elongation of the distal interosseous ligament, anterior inferior tibiofibular ligament, and the posterior inferior tibiofibular ligament were measured bilaterally. Comparisons were made between the operative and uninjured sides. Clinical outcomes were evaluated with use of the Foot and Ankle Ability Measure.
Static load increased the lengths of the distal interosseous ligament (p = 0.02 to 0.05) and middle segment of the anterior inferior tibiofibular ligament (p = 0.02) in the operative ankle. The distal syndesmosis length was greater on the operative side during the static unloaded and loaded conditions (p = 0.02). Length of the distal syndesmosis on the operative side was greater than the corresponding healthy syndesmosis length during all 3 dynamic activities. On average, the operative ankle was in less dorsiflexion over the support phase of the angled hop (p = 0.05) and running (p < 0.01). The average Foot and Ankle Ability Measure Activities of Daily Living and Sports subscale scores were 95 and 88, respectively.
This study provides the first in vivo evidence of post-fixation changes in biomechanics after syndesmosis repair. Syndesmosis repair fails to restore healthy static and dynamic distal tibiofibular anatomy, even in patients who report good to excellent clinical outcomes.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
踝关节韧带损伤是运动员和普通人群中最常见的损伤，美国每年约有 200 万人受伤。踝关节联合损伤（即“高位踝关节扭伤”）一般采用手术治疗。虽然尸体研究可以评估联合固定强度，但不能预测愈合、神经肌肉适应或动态加载如何影响体内生物力学。我们使用动态双平面放射摄影（DBR）测试了这样一个假设，即联合修复将在静态和动态加载过程中恢复踝关节运动学和韧带伸长。
我们对 6 名男性患者进行了便利抽样，这些患者在接受手术固定（2 枚螺钉、3 枚悬吊、1 枚混合）治疗联合损伤后，在术后 2 至 4.5 年期间使用 DBR 进行了前向跑步、后退跑、45°倾斜单腿跳跃和 1 个静态站立试验，评估了双侧踝关节的三维运动学和骨间远侧韧带、前下胫腓韧带和后下胫腓韧带的伸长情况。对手术侧和未受伤侧进行了比较。使用足踝能力测量法评估临床结果。
在静态负荷下，手术侧的骨间远侧韧带（p=0.02 至 0.05）和前下胫腓韧带中段（p=0.02）的长度增加。在静态无负荷和负荷条件下，手术侧的远侧联合长度更大（p=0.02）。在所有 3 种动态活动中，手术侧的远侧联合长度均大于相应的健康联合长度。平均而言，在倾斜跳跃和跑步的支撑阶段，手术踝关节的背屈度较小（p=0.05）。足踝能力测量日常生活活动和运动子量表的平均评分分别为 95 和 88。
这项研究首次提供了体内生物力学在联合修复后的固定变化证据。即使在报告临床结果良好至优秀的患者中，联合修复也无法恢复健康的静态和动态下胫腓联合解剖结构。
治疗 IV 级。请参阅作者说明，以获取完整的证据等级描述。
