Dias Shiluka, Lewis Thomas L, Alkhalfan Yousif, Ahluwalia Raju, Ray Robbie
Guy's and St Thomas' NHS Foundation Trust, London, UK.
King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
J Orthop. 2022 Jul 19;33:87-94. doi: 10.1016/j.jor.2022.07.006. eCollection 2022 Sep-Oct.
BACKGROUND/AIMS: Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI).
The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI.
Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes.
Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
背景/目的：踝关节扭伤是常见损伤，可导致慢性外侧踝关节韧带不稳定（CAI）。
本综述的目的是全面概述CAI的流行病学、病理生理学、检查、手术治疗和康复。
CAI的检查基于病史、临床检查和影像学。CAI的手术治疗可定义为ATFL和/或CFL的解剖重建、解剖和非解剖修复。与非解剖修复相比，解剖修复已显示出更好的功能结果和更少的继发性骨关节炎。非解剖方法不能复制ATFL/CFL的正常解剖路径，可能导致僵硬。CAI最常见的手术治疗是采用Gould改良的开放改良Broström修复术。正在开发的关节镜技术已报告了有前景的临床结果。然而，仍有相当多的领域需要进一步研究，以提高对当前治疗选择的理解和有效性。标准化验证的患者报告结局测量和康复期基于证据的方案对于积极和可重复的结果至关重要。
手术修复已被证明对CAI患者有优异的结果，然而应进行更大规模的前瞻性研究以评估更新手术技术的应用。
