Dallas Orthopedic and Shoulder Institute, Sunnyvale, Texas.
Thibodaux Regional Medical Center, Thibodaux, Louisiana.
Foot Ankle Spec. 2023 Jun;16(3):192-204. doi: 10.1177/19386400211041897. Epub 2021 Dec 7.
Lateral ankle instability is not uncommon after osseous cuts and soft tissue releases are performed during Total Ankle Arthroplasty (TAA), particularly with varus malalignment. The purpose of the present study was to compare the outcomes of ankles that underwent TAA with concurrent Brostrom-Gould (BG) or Anatomic Lateral Ankle Stabilization (ATLAS) at a minimum of 1-year follow-up.
Thirty-eight TAAs underwent BG (21 INFINITY, 4 CADENCE) or ATLAS (13 INBONE-2) between August 2015 and February 2019 at a single institution and were at least 1 year postoperative (mean 18.3 months, range: 12-40). Baseline patient demographics, characteristics, and operative factors were assessed via medical record and chart reviews. Radiographs parameters were measured preoperatively, at 6 weeks postoperative, and during the latest follow-up. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed.
Survivorship for TAA with concurrent BG/ATLAS was 97%. Overall, TAA with concurrent BG had higher incidences of early TAA revision (4%), recurrent instability (4%), reoperation (16%), and complications (29%) compared to ATLAS. Postoperative coronal and sagittal tibiotalar alignment changes were significant for both groups (P < .001, P = .014); however, the differences were greater for ATLAS (P = .045, P < .001).
The present study is the first to compare outcomes between techniques for addressing ankle instability in the TAA population. At short-term follow-up, anatomic reconstruction produced better outcomes than the traditional BG procedure. Additional comparative studies between techniques to address instability in the TAA population are warranted.
Level III: Retrospective cohort study.
全踝关节置换术（Total Ankle Arthroplasty，TAA）中进行骨截骨和软组织松解后，常发生外侧踝关节不稳定，尤其是存在内翻畸形时。本研究旨在比较至少 1 年随访时接受 Brostrom-Gould（BG）或解剖外侧踝关节稳定术（Anatomic Lateral Ankle Stabilization，ATLAS）的 TAA 踝关节的结果。
2015 年 8 月至 2019 年 2 月，在一家医疗机构对 38 例 TAA 患者施行 BG（21 例 INFINITY，4 例 CADENCE）或 ATLAS（13 例 INBONE-2）手术，术后至少随访 1 年（平均 18.3 个月，范围：12-40 个月）。通过病历和图表回顾评估患者的基线人口统计学、特征和手术因素。在术前、术后 6 周和末次随访时测量 X 线片参数。根据 Vander Griend 等人和 Glazebrook 等人的标准分别对翻修、再手术和并发症进行分类。进行单变量和多变量分析。
TAA 同期行 BG/ATLAS 的生存率为 97%。总体而言，与 ATLAS 相比，同期行 BG 的 TAA 早期 TAA 翻修率（4%）、复发性不稳定（4%）、再手术率（16%）和并发症发生率（29%）更高。两组术后冠状位和矢状位胫距关节对线变化均有统计学意义（P <.001，P =.014）；然而，ATLAS 的差异更大（P =.045，P <.001）。
本研究首次比较了 TAA 人群中治疗踝关节不稳定的两种技术的结果。短期随访时，解剖重建的效果优于传统的 BG 手术。有必要开展针对 TAA 人群中不稳定问题的不同技术之间的比较研究。
III 级：回顾性队列研究。
