Chen Ziyi, Xue Xiao'ao, Li Qiaoru, Song Yujie, Xu Hanlin, Wang Wenjuan, Hua Yinghui
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Int Orthop. 2023 Apr;47(4):995-1003. doi: 10.1007/s00264-023-05721-0. Epub 2023 Feb 15.
This study aimed to introduce a novel all-inside arthroscopic anterior talofibular ligament (ATFL) repair for chronic ankle instability (CAI) with a knotless suture anchor technique-Hugging Repair, evaluate clinical outcomes, and analyze the associated risk factors.
A total of 84 patients (42 males and 42 females, mean age: 36.1 ± 11.2 years, range: 19-68 years) who underwent Hugging Repair from January 1, 2016 to December 31, 2018, were enrolled in this retrospective study. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS), Tegner score, and Numerical Rating Scale (NRS) were evaluated pre-operatively and at final follow-up. The potential risk factors such as age, body mass index (BMI), sex, post-injury duration (time from injury to surgery), follow-up time, number of anchors, concomitant injuries [e.g., osteochondral defects (OCD), sinus tarsi syndrome (STS), anterior ankle impingement (AAI)], first-time treatment, and number of ankle sprains were also analyzed through multiple regression analysis.
There were 68 (81%) patients followed up for a mean time of 42 (range: 35-50) months. The median AOFAS score increased from 65 (35-72) to 90 (77-100), KAFS increased from 64 (38-71) to 90 (62-100), FAOS increased from 68 (50-70) to 97 (68-100), Tegner score increased from 1 (1-3) to 4 (2-7), and NRS increased from 3.5 (2-5) to 1 (0-3). No correlation was found between the functional scores and risk factors mentioned above. In the multivariate model, age was significantly negatively associated with KAFS, FAOS, and Tegner activity scale (P = 0.013; P = 0.002; P = 0.000); female was significantly associated with poorer Tegner activity scale (P = 0.004); and the presence of concomitant injuries was significantly negatively associated with AOFAS score (P = 0.033).
The novel all-inside arthroscopic ATFL repair for CAI with a knotless suture anchor technique-Hugging Repair is a safe and suitable technique that achieves satisfactory clinical outcomes and provides an effective option for the treatment of CAI. Risk factors for patients who underwent all-inside ATFL repair were older age, female sex, and concomitant injuries.
本研究旨在介绍一种采用无结缝线锚钉技术——环抱修复术对慢性踝关节不稳（CAI）进行的新型全关节镜下距腓前韧带（ATFL）修复术，评估临床疗效，并分析相关危险因素。
本回顾性研究纳入了2016年1月1日至2018年12月31日期间接受环抱修复术的84例患者（男42例，女42例，平均年龄：36.1±11.2岁，范围：19 - 68岁）。术前及末次随访时评估美国矫形足踝协会（AOFAS）评分、卡尔森踝关节功能评分（KAFS）、足踝结果评分（FAOS）、特格纳评分及数字评定量表（NRS）。还通过多元回归分析了年龄、体重指数（BMI）、性别、伤后持续时间（从受伤至手术的时间）、随访时间、锚钉数量、合并损伤[如骨软骨损伤（OCD）、距下窦综合征（STS）、踝关节前部撞击（AAI）]、首次治疗及踝关节扭伤次数等潜在危险因素。
68例（81%）患者获得随访，平均随访时间为42（范围：35 - 50）个月。AOFAS评分中位数从65（35 - 72）提高到90（77 - 100），KAFS评分从64（38 - 71）提高到90（62 - 100），FAOS评分从68（50 - 70）提高到97（68 - 100），特格纳评分从1（1 - 3）提高到4（2 - 7），NRS评分从3.5（2 - 5）提高到'1（0 - 3）。未发现上述功能评分与危险因素之间存在相关性。在多变量模型中，年龄与KAFS、FAOS及特格纳活动量表显著负相关（P = 0.013；P = 0.002；P = 0.000）；女性与较差的特格纳活动量表显著相关（P = 0.004）；合并损伤的存在与AOFAS评分显著负相关（P = 0.033）。
采用无结缝线锚钉技术——环抱修复术对CAI进行的新型全关节镜下ATFL修复术是一种安全且合适的技术，能取得满意的临床疗效，为CAI的治疗提供了一种有效的选择。接受全关节镜下ATFL修复术患者的危险因素为年龄较大、女性及合并损伤。
