Al-Janabi Mina Mazin, Apostolides Michael, Southgate Crispin, Dhinsa Baljinder Singh
The Princess Alexandra Hospital NHS Trust, United Kingdom.
East Kent Hospitals University Foundation Trust, United Kingdom.
Foot (Edinb). 2023 May;55:101988. doi: 10.1016/j.foot.2023.101988. Epub 2023 Feb 24.
Emergency departments in the UK are overwhelmed with musculoskeletal trauma, 50 % of which resulting from ligamentous injuries. Of these, ankle sprains are the most prevalent, however with poor rehabilitation in the recovery period, 20 % of patients may develop chronic instability that may necessitate operative reconstruction. At present, there are no national guidelines or protocols to help direct postoperative rehabilitation and determine weightbearing status. Our aim is to review the existing literature that investigated postoperative outcomes following different rehabilitation protocols in patients with Chronic Lateral Collateral Ligament (CLCL) instability.
A literature search was performed via Medline, Embase and Pubmed databases using the terms 'ankle', 'lateral ligament', 'repair'. 'reconstruction' and 'early mobilisation'. A total of 19 studies were identified after filtering that they were English language papers. A gray literature search was also performed using the Google search engine.
Based on the literature reviewed, patients undergoing early mobilisation and Range Of Movement (ROM) following lateral ligament reconstruction for chronic instability seem to have better functional outcomes and earlier return to work and sports. This is however in the short-term, and there are no medium to long-term studies evaluating the effects of early mobilisation on ankle stability. Furthermore, there may be an increased risk of postoperative complications, mainly wound related, with early mobilization compared to delayed mobilization.
Further randomized studies and long-term prospective studies with larger cohorts of patients are required to improve the level of evidence available but based on current literature it would appear that controlled early ROM and weight-bearing is advisable in patients undergoing surgery for CLCL instability.
英国急诊科收治了大量肌肉骨骼创伤患者，其中50%是由韧带损伤所致。在这些韧带损伤中，踝关节扭伤最为常见，但由于恢复期康复不佳，20%的患者可能会出现慢性不稳定，这可能需要进行手术重建。目前，尚无国家指南或方案来指导术后康复及确定负重状态。我们的目的是回顾现有文献，这些文献研究了慢性外侧副韧带（CLCL）不稳定患者采用不同康复方案后的术后结果。
通过Medline、Embase和Pubmed数据库进行文献检索，检索词为“踝关节”“外侧韧带”“修复”“重建”和“早期活动”。筛选后共确定了19篇英文文献。还使用谷歌搜索引擎进行了灰色文献检索。
基于所回顾的文献，对于慢性不稳定患者，外侧韧带重建术后早期活动及进行活动范围（ROM）训练的患者似乎功能结局更好，能更早重返工作和运动。然而，这只是短期情况，尚无中长期研究评估早期活动对踝关节稳定性的影响。此外，与延迟活动相比，早期活动可能会增加术后并发症的风险，主要是与伤口相关的并发症。
需要进一步开展随机研究和针对更大患者队列的长期前瞻性研究，以提高现有证据水平，但基于目前的文献，对于接受CLCL不稳定手术的患者，建议进行有控制的早期ROM训练和负重训练。
