Boutelle Kelly E, Rickert Kathleen D, Carroll Alyssa N, Pennock Andrew T, Manhard Claire E, Edmonds Eric W
Rady Children's Hospital.
University of California San Diego, San Diego, CA.
J Pediatr Orthop. 2023 Mar 1;43(3):e199-e203. doi: 10.1097/BPO.0000000000002329. Epub 2022 Dec 15.
Once a child has developed chronic ankle instability with recurrent events despite conservative treatment, then ligamentous repair is warranted. We utilize a modification of the modified Broström-Gould technique that further incorporates the distal fibular periosteum into the construct. The purpose of this study was to describe the intermediate-term outcomes of our modified Broström-Gould technique for chronic lateral ankle instability in childhood athletes.
A retrospective review of children who underwent the surgical technique over a 10-year time period (2010 to 2019) was performed, excluding those with <2 years of follow-up. Demographic, surgical, and clinical data were recorded, as well as outcome scores: (1) the Marx activity scale, (2) University of California, Los Angeles activity score, and (3) foot and ankle outcomes score. Recurrent instability events, repeat surgeries, satisfaction with the surgical experience, and return to sport (if applicable) were also recorded.
Forty-six children (43 females) with 1 bilateral ankle met the criteria with a mean age at surgery of 14.8 years, and a mean follow-up duration of 4.9 years. The mean Marx activity score was 9.0±5.1, the mean University of California, Los Angeles score was 8.3±1.8, and the mean total foot and ankle outcomes score was 84.0±15.6. Twenty-six ankles (55.3%) reported having at least 1 recurrent episode of instability and 6 of the ankles (12.8%) underwent revision surgery between 3.5 months and 6.5 years of the index procedure. Thirty-nine (84.8%) patients responded that they would undergo our surgery again.
A modified Broström-Gould procedure can be performed in children with the incorporation of the adjacent periosteum, but recurrence of instability is distinctly possible with longer follow-up with a risk for revision surgery despite good subjective outcomes.
Level IV; retrospective case series.
一旦儿童在接受保守治疗后仍反复出现慢性踝关节不稳，那么就有必要进行韧带修复。我们采用改良的Broström-Gould技术，进一步将腓骨远端骨膜纳入修复结构中。本研究的目的是描述我们改良的Broström-Gould技术治疗儿童运动员慢性外侧踝关节不稳的中期疗效。
对在10年期间（2010年至2019年）接受该手术技术治疗的儿童进行回顾性研究，排除随访时间不足2年的患者。记录人口统计学、手术和临床数据以及疗效评分：（1）马克思活动量表，（2）加利福尼亚大学洛杉矶分校活动评分，以及（3）足踝疗效评分。还记录了复发性不稳事件、再次手术情况、对手术体验的满意度以及恢复运动情况（如适用）。
46名儿童（43名女性）的1个双侧踝关节符合标准，手术时的平均年龄为14.8岁，平均随访时间为4.9年。马克思活动量表的平均评分为9.0±5.1，加利福尼亚大学洛杉矶分校的平均评分为8.3±1.8，足踝疗效总分的平均评分为84.0±15.6。26个踝关节（55.3%）报告至少有1次复发性不稳发作，其中6个踝关节（12.8%）在初次手术后3.5个月至6.5年之间接受了翻修手术。39名（84.8%）患者表示愿意再次接受我们的手术。
改良的Broström-Gould手术可用于儿童，并纳入相邻骨膜，但随着随访时间延长，不稳复发明显可能，尽管主观疗效良好，但仍有翻修手术风险。
IV级；回顾性病例系列。
