Su Tong, Du Ming-Ze, Parekh Selene G, Jiang Yan-Fang, Jiao Chen, Hu Yue-Lin, Guo Qin-Wei, Jiang Dong
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Foot Ankle Int. 2023 Apr;44(4):270-278. doi: 10.1177/10711007231153388. Epub 2023 Mar 10.
Tibiofibular syndesmosis (TFS) widening sometimes is not evident on radiography but can be found under arthroscopy in chronic lateral ankle instability (CLAI). This study aimed to evaluate the effect of TFS widening severity on clinical outcomes and return to activities after isolated Broström operation in CLAI patients and to propose an indication for its surgical intervention.
A total of 118 CLAI patients undergoing diagnostic ankle arthroscopy and open Broström-Gould operation were included. Based on the middle width of TFS measured under arthroscopy, patients were divided into the TFS-2 group (≤2 mm, n = 44), the TFS-3 group (2-4 mm, n = 42), and the TFS-4 group (≥4 mm, n = 32). The time to return to recreational sport and work, Tegner activity score, and proportion of returning to preinjury sports at the final follow-up were evaluated and compared. Other subjective evaluations included the American Orthopaedic Foot & Ankle Society score, visual analog scale, and Karlsson-Peterson score.
Among the 3 groups, the TFS-4 group demonstrated the longest mean time to return to work and recreational sports, with the lowest proportion returning to preinjury sports. The TFS-4 group showed a significantly higher rate of sprain recurrence (12.5%) than the other 2 groups ( =.021). All the other subjective scores significantly improved after the operation without differences among the 3 groups.
Concomitant severe syndesmotic widening adversely affects the return to activities after Broström operation in CLAI cases. The CLAI patients with a middle TFS width ≥4 mm were associated with delayed return to work and sports, a lower proportion of returning to preinjury sports, and more sprain recurrence, which might require further surgical intervention for syndesmosis in addition to Broström surgery.
Level III, retrospective cohort study.
在慢性外侧踝关节不稳（CLAI）患者中，胫腓下联合（TFS）增宽在X线片上有时并不明显，但在关节镜检查时可以发现。本研究旨在评估CLAI患者单纯行Broström手术时，TFS增宽严重程度对临床疗效及恢复活动情况的影响，并提出其手术干预的指征。
共纳入118例行诊断性踝关节镜检查及开放性Broström-Gould手术的CLAI患者。根据关节镜下测量的TFS中间宽度，将患者分为TFS-2组（≤2 mm，n = 44）、TFS-3组（2 - 4 mm，n = 42）和TFS-4组（≥4 mm，n = 32）。评估并比较恢复娱乐性运动和工作的时间、Tegner活动评分以及末次随访时恢复到伤前运动水平的比例。其他主观评估包括美国矫形足踝协会评分、视觉模拟量表评分和Karlsson-Peterson评分。
在3组中，TFS-4组恢复工作和娱乐性运动的平均时间最长，恢复到伤前运动水平的比例最低。TFS-4组的扭伤复发率（12.5%）显著高于其他2组（P = 0.021）。术后所有其他主观评分均显著改善，3组间无差异。
在CLAI病例中，合并严重的下胫腓联合增宽会对Broström手术后的活动恢复产生不利影响。TFS中间宽度≥4 mm的CLAI患者恢复工作和运动的时间延迟，恢复到伤前运动水平的比例较低，扭伤复发更多，除了Broström手术外，可能还需要对下胫腓联合进行进一步的手术干预。
III级，回顾性队列研究。
