Department of Orthopedic Surgery, Seoul Now Hospital, Anyang, Republic of Korea.
Department of Orthopaedic Surgery, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3543-3550. doi: 10.1007/s00167-021-06651-3. Epub 2021 Sep 29.
To evaluate the arthroscopic findings of subtalar joints, including interosseous talocalcaneal ligament (ITCL) tear, in patients with chronic lateral ankle instability (CLAI) and sinus tarsi pain.
A total of 118 ankles (109 patients) having CLAI with sinus tarsi pain who had undergone subtalar arthroscopy and lateral ankle ligament surgery were evaluated. The medical records, radiologic images, and the arthroscopic images and videos were reviewed. ITCL tears were classified into 4 grades: grade 0 (no tear), grade 1 (mild), grade 2 (moderate), and grade 3 (severe). The efficacy of magnetic resonance imaging (MRI) in diagnosing ITCL tears was also evaluated by comparing preoperative official readings of MRI to arthroscopic findings. The pre- and postoperative functional scores were also assessed.
The overall tear rate of ITCL was 107/118 (90.7%). There were 29 ankles (23.6%) with grade 1, 42 ankles (35.6%) with grade 2, and 36 ankles (30.5%) with grade 3 tears. Isolated lateral ankle instability (LAI) was diagnosed in 43 ankles (36.4%), subtalar instability (STI) in 30 ankles (25.4%), and LAI with STI in 45 ankles (38.1%). There was a statistically significant relationship between the ITCL tear grade and the final diagnosis. ITCL tear was confirmed or suspected in 81 ankles (68.6%) on preoperative MRI. Pain Visual Analog Score and functional outcome scores including the American Orthopaedic Foot & Ankle Society and Karlsson-Peterson scores showed significant improvement after the surgery.
A high rate (90.7%) of ITCL tears was noted in CLAI patients with sinus tarsi pain. ITCL damage may play an important role in subtalar instability in patients with CLAI and sinus tarsi pain. Subtalar arthroscopic evaluation for ITCL tear is important for correct diagnosis for CLAI with sinus tarsi pain.
IV.
评估慢性外侧踝关节不稳定（CLAI）伴跗骨窦疼痛患者的跗骨间关节的关节镜表现，包括跗骨间跟骨-跟骨间韧带（ITCL）撕裂。
对 118 例（109 例患者）接受跗骨关节镜和外踝韧带手术的伴有跗骨窦疼痛的 CLAI 患者进行评估。回顾了病历、影像学图像以及关节镜图像和视频。将 ITCL 撕裂分为 4 个等级：0 级（无撕裂）、1 级（轻度）、2 级（中度）和 3 级（重度）。还通过比较术前 MRI 的正式读数与关节镜检查结果来评估 MRI 诊断 ITCL 撕裂的有效性。同时评估了术前和术后的功能评分。
ITCL 的总撕裂率为 107/118（90.7%）。有 29 例（23.6%）为 1 级撕裂，42 例（35.6%）为 2 级撕裂，36 例（30.5%）为 3 级撕裂。孤立性外踝不稳定（LAI）诊断为 43 例（36.4%），跗骨下不稳定（STI）诊断为 30 例（25.4%），LAI 合并 STI 诊断为 45 例（38.1%）。ITCL 撕裂程度与最终诊断之间存在统计学显著关系。术前 MRI 证实或疑似 ITCL 撕裂 81 例（68.6%）。手术后，疼痛视觉模拟评分和包括美国矫形足踝协会和 Karlsson-Peterson 评分在内的功能评分均显著改善。
在伴有跗骨窦疼痛的 CLAI 患者中，发现 ITCL 撕裂的发生率很高（90.7%）。ITCL 损伤可能在外踝不稳定合并跗骨窦疼痛患者的跗骨下不稳定中起重要作用。跗骨关节镜评估 ITCL 撕裂对于正确诊断伴有跗骨窦疼痛的 CLAI 非常重要。
IV。
