采用距腓前韧带和跟腓韧带之间的夹角评估慢性踝关节不稳定和距下关节不稳定。
Evaluation of chronic ankle instability and subtalar instability using the angle between the anterior talofibular ligament and calcaneofibular ligament.
机构信息
Department of Orthopedic Surgery, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea.
Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4539-4545. doi: 10.1007/s00167-023-07433-9. Epub 2023 Jun 7.
PURPOSE
A series of studies have reported a change in the length or thickness of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments in patients with chronic ankle instability. However, no study has examined the changes in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability. Therefore, this study analyzed the change in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability to confirm its relevance.
METHODS
This retrospective study included 60 patients who had undergone surgery for chronic ankle instability. Stress radiographs comprising the anterior drawer test, varus stress test, Broden's view stress test, and magnetic resonance imaging (MRI) were performed in all patients. The angle between the ATFL and CFL was measured by indicating the vector at the attachment site, as seen on the sagittal plane. Three groups were classified according to the angle between the two ligaments measured by MRI: group I when the angle was > 90°, Group II when the angle was 71-90°, and Group III when the angle was ≤ 70°. The accompanying injuries to the subtalar joint ligament were analyzed via MRI.
RESULTS
A comparison of the angles between the ATFL and CFL measured on MRI in Group I, Group II, and Group III with the angles measured in the operating room revealed a significant correlation. Broden's view stress test revealed a statistically significant difference among the three groups (p < 0.05). The accompanying subtalar joint ligament injuries differed significantly among the three groups (p < 0.05).
CONCLUSION
The ATFL-CFL angle in patients with ankle instability is smaller than the average angle in ordinary people. Therefore, the ATFL-CFL angle might be a reliable and representative measurement tool to assess chronic ankle instability, and subtalar joint instability should be considered if the ATFL-CFL angle is 70° or less.
LEVEL OF EVIDENCE
Level III.
目的
多项研究报道慢性踝关节不稳患者的距腓前韧带（ATFL）和跟腓韧带（CFL）长度或厚度发生改变。然而，尚无研究检查过慢性踝关节不稳患者 ATFL 和 CFL 之间角度的变化。因此，本研究分析了诊断为慢性踝关节不稳患者 ATFL 和 CFL 之间角度的变化，以确认其相关性。
方法
本回顾性研究纳入 60 例行慢性踝关节不稳手术的患者。所有患者均行前抽屉试验、内翻应力试验、Broden 位应力试验和磁共振成像（MRI）检查。在矢状面上测量附着点处的向量，以确定 ATFL 和 CFL 之间的角度。根据 MRI 测量的两条韧带之间的角度将患者分为三组：角度>90°为 Group I，71-90°为 Group II，≤70°为 Group III。通过 MRI 分析距下关节韧带的伴随损伤。
结果
与术中测量的 ATFL 和 CFL 角度相比，MRI 测量的 Group I、Group II 和 Group III 的角度之间存在显著相关性。Broden 位应力试验显示三组间差异有统计学意义（p<0.05）。三组的距下关节韧带伴随损伤存在显著差异（p<0.05）。
结论
踝关节不稳患者的 ATFL-CFL 角度小于普通人的平均角度。因此，ATFL-CFL 角度可能是评估慢性踝关节不稳的可靠且有代表性的测量工具，如果 ATFL-CFL 角度为 70°或更小，则应考虑距下关节不稳。
证据等级
III 级。
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