外侧踝关节韧带修复后再不稳定的危险因素。
Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair.
机构信息
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Orthopaedics and Traumatology, Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia.
出版信息
Foot Ankle Int. 2023 Jul;44(7):617-628. doi: 10.1177/10711007231171080. Epub 2023 May 10.
BACKGROUND
Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI.
METHODS
Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups-nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)-and clinical outcomes were compared.
RESULTS
Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group.
CONCLUSION
Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
关节镜下前距腓韧带（ATFL）修复术广泛应用于慢性外侧踝关节不稳定（CLAI）。尽管许多研究报告了该手术的良好结果，但不稳定的复发仍然是一个常见的关注点。因此，本研究旨在分析关节镜下修复 CLAI 后不稳定复发的危险因素。
方法
回顾性分析 53 例 56 例踝关节患者的临床资料，平均年龄 31.8±14.7 岁。所有患者均接受关节镜下 ATFL 修复术。如果 ATFL 修复后仍不稳定，则行跟腓韧带（CFL）修复术。术前评估踝关节活动评分（AAS），并在术前及末次随访时评估日本足外科协会评分、Karlsson-Peterson 评分和自我管理足部评估问卷（SAFE-Q）。术前和术后 1 年评估距骨倾斜角（TTA）。根据术后 TTA 将踝关节分为无复发组（<6 度）和复发组（≥6 度），比较两组临床结果。
结果
16 例踝关节出现复发性不稳定，40 例无复发。术前，复发组 AAS、TTA 和 SAFE-Q 的社会功能评分明显高于无复发组。此外，复发组术前 ATFL 残端质量差和 CFL 未修复的比例明显高于无复发组，尽管术前诊断存在 CFL 损伤。
结论
对于术前活动度高、残端质量差、忽视 CFL 损伤的 ATFL 和 CFL 缺损，关节镜修复可能导致不稳定复发。对于这些踝关节，应选择适当的手术程序以预防不稳定的复发。
证据等级
IV 级，回顾性病例系列。
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