Qingdao University, Qingdao, Shandong, China.
NO.1 District Department of Orthopedics, No. 971 Army Navy hospital of People's Liberation, Qingdao, Shandong, China.
BMC Musculoskelet Disord. 2022 Jan 4;23(1):28. doi: 10.1186/s12891-021-04932-z.
The Brostrom-Gould procedure is currently the gold standard surgical choice for the treatment of chronic ankle instability; it can significantly improve ankle function and stability in patients. However, recent studies have reported doubts regarding the feasibility of the inferior extensor retinaculum (IER) after Brostrom-Gould and therapeutic effects compared with the Brostrom procedure. The purpose of the present study was to observe the anatomical characteristics of the lateral part of the IER using cadaveric bodies in order to guide the surgical operation of chronic ankle instability.
Twenty-three cadaveric ankles were dissected. The morphology of the IER and its internal structure was observed and recorded for each ankle. The shortest distance between the Stem ligament of the IER and the anterior fibular periosteum (AFP) was measured and recorded, then attempts were made to suture the Stem to the AFP.
Twelve of the cadaveric ankles were observed as having an oblique superolateral band (OSLB) that had a tough texture upward of the lateral IER connecting with SL, as are the characteristics of the oblique superolateral band (OSLB) reported in previous studies. The inner and outer membrane of the OSLB were connected with inner and outer membrane of Stem. The average value of the distance between the Stem and AFP was 11.60 ± 2.71 mm, and the maximum and the minimum distance were 19.04 mm and 6.53 mm, respectively. The P -value (P = 0.2) resulting from a single sample K-S test confirmed that the distribution of distances conformed to normality. None of the SL in the study could be sutured to the AFP.
The OSLB of the IER has a tough texture and connects with the Stem, and has the potential be utilised in the Brostrom-Gould procedure. However, we do not recommend utilization of the Stem in this operation regardless of the distance between the AFP and the Stem. When the Stem cannot be used to enhance repair in this operation, other solutions can be used for strengthening and to protect the repaired ATFL.
Brostrom-Gould 手术目前是慢性踝关节不稳定治疗的金标准手术选择；它可以显著改善患者的踝关节功能和稳定性。然而，最近的研究报告对 Brostrom-Gould 术后下伸肌支持带（IER）的可行性以及与 Brostrom 手术的治疗效果产生了质疑。本研究的目的是通过尸体解剖观察 IER 的外侧部分的解剖学特征，以指导慢性踝关节不稳定的手术操作。
解剖了 23 个尸体踝关节。观察并记录每个踝关节 IER 的形态及其内部结构。测量并记录 IER 的 Stem 韧带与前腓骨骨膜（AFP）之间的最短距离，然后尝试将 Stem 缝合到 AFP 上。
12 个尸体踝关节观察到斜上方带（OSLB），其质地坚韧，向上连接外侧 IER 与 SL，与先前研究报道的斜上方带（OSLB）的特征一致。OSLB 的内、外膜与 Stem 的内、外膜相连。Stem 与 AFP 之间的平均距离为 11.60±2.71mm，最大和最小距离分别为 19.04mm 和 6.53mm。单一样本 K-S 检验得到的 P 值（P=0.2）证实，距离分布符合正态性。本研究中没有一条 SL 可以缝合到 AFP 上。
IER 的 OSLB 质地坚韧，与 Stem 相连，有可能在 Brostrom-Gould 手术中得到应用。然而，无论 AFP 和 Stem 之间的距离如何，我们都不建议在该手术中使用 Stem。当 Stem 不能用于增强该手术中的修复时，可以使用其他解决方案来加强和保护修复后的 ATFL。
