解剖重建使用自体股薄肌腱比 Broström-Gould 手术更能减少扭伤复发，但在慢性外侧踝关节不稳定中恢复时间延长。

Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability.

机构信息

Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4181-4188. doi: 10.1007/s00167-022-07011-5. Epub 2022 Jun 8.

DOI:10.1007/s00167-022-07011-5

PMID:35674772

Abstract

PURPOSE

To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques.

METHODS

From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson-Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups.

RESULTS

All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group.

CONCLUSIONS

Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand.

LEVEL OF EVIDENCE

III.

摘要

目的

比较慢性踝关节外侧不稳定（CLAI）患者应用自体股薄肌腱解剖重建与改良 Broström-Gould（MBG）手术治疗后重返活动和长期临床结果。假设两种技术之间没有差异。

方法

2013 年至 2018 年，我院对 30 例经前抽屉试验证实为 III 级关节不稳定的 CLAI 患者采用自体股薄肌腱（重建组）进行解剖重建外侧踝关节韧带。根据人口统计学参数，以 1:1 的比例将另外 30 例接受 MBG 手术的患者（MBG 组）进行匹配。回顾性评估并比较两组患者术后美国矫形足踝协会（AOFAS）评分、视觉模拟评分（VAS）疼痛评分、Tegner 活动评分、Karlsson-Peterson 评分、手术并发症、重返活动和工作情况。

结果

两组患者术后所有主观评分均显著改善（均 p<0.001），但两组间无差异（均 n.s.）。MBG 组术后踝关节扭伤复发比例明显高于重建组（26.7%比 0，p=0.002）。重建组开始完全负重行走、慢跑和恢复工作的时间均明显长于 MBG 组（10.5±6.9 比 7.0±3.1 周，p=0.015；17.1±8.9 比 12.7±6.9 周，p=0.043；13.5±12.6 比 8.0±4.7 周，p=0.039）。