Flaherty David J, McGuigan Jamie, Cullen Samuel E, Pillai Anand
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR.
Cureus. 2023 Sep 2;15(9):e44563. doi: 10.7759/cureus.44563. eCollection 2023 Sep.
Background Chronic lateral ankle instability (CLAI) is caused by lateral ankle ligament weakness or rupture secondary to recurrent sprains. The surgical management has traditionally involved a modified Broström-Gould (MBG) procedure with or without internal brace (IB) augmentation. This study aims to demonstrate the improved outcomes for patients undergoing an MBG procedure with IB augmentation for CLAI. Methodology A retrospective analysis was performed among 40 patients undergoing an MBG procedure with or without IB for CLAI at a large teaching hospital between January 2012 and June 2019. Functional outcomes were measured using the Manchester-Oxford Foot Questionnaire (MOxFQ). Clinic letters were reviewed to assess additional outcomes including postoperative complications, revision surgery rate, time in a plaster cast, and time to full weight-bearing. Results A total of 23 patients were included in the study, with seven undergoing both MBG and IB procedures and 16 undergoing MBG intervention alone. The average age was 37.1 years in the IB group and 35.7 years in the MBG group. The mean MOxFQ overall raw scores (10.9 vs. 33.6, p < 0.016), standing and walking MOxFQ subscale (4 vs. 15.2, p < 0.012), pain MOxFQ subscale (4.86 vs. 10.9, p < 0.042), and social interaction subscale (2 vs. 7.5 p < 0.023) all showed significantly better results for the IB group versus the MBG group. Patients in the IB group had significantly less number of weeks in plaster than the MBG group and were able to fully weight bear sooner (4.14 vs. 6, p < 0.01). The MBG group suffered a postoperative complication in seven patients compared to zero in the IB group (p < 0.057). There were three re-ruptures in the MBG group requiring further revision surgery compared to zero in the IB group (3 vs. 0, p < 0.53). Conclusions MBG surgery with IB augmentation for CLAI appears to have better outcomes in terms of overall function and may have fewer overall complications. The IB group displayed a lower recurrence of pain, less time in a plaster cast, and a quicker return to walking.
慢性外侧踝关节不稳（CLAI）是由反复扭伤继发的外侧踝关节韧带薄弱或断裂引起的。传统的手术治疗包括改良的布罗斯特伦-古尔德（MBG）手术，可加用或不加用内置支撑（IB）增强。本研究旨在证明接受MBG手术并加用IB增强治疗CLAI的患者有更好的疗效。方法：对2012年1月至2019年6月在一家大型教学医院接受MBG手术（加用或不加用IB）治疗CLAI的40例患者进行回顾性分析。使用曼彻斯特-牛津足部问卷（MOxFQ）测量功能结局。查阅临床信件以评估其他结局，包括术后并发症、翻修手术率、石膏固定时间和完全负重时间。结果：本研究共纳入23例患者，其中7例接受了MBG和IB手术，16例仅接受了MBG干预。IB组的平均年龄为37.1岁，MBG组为35.7岁。IB组的平均MOxFQ总体原始得分（10.9对33.6，p<0.016）、站立和行走MOxFQ子量表得分（4对15.2，p<0.012）、疼痛MOxFQ子量表得分（4.86对10.9，p<0.042）以及社交互动子量表得分（2对7.5，p<0.023）均显著优于MBG组。IB组患者的石膏固定周数明显少于MBG组，且能更快完全负重（4.14对6，p<0.01）。MBG组有7例患者出现术后并发症，而IB组为零（p<0.057）。MBG组有3例再次断裂需要进一步翻修手术，而IB组为零（3对0，p<0.53）。结论：MBG手术加用IB增强治疗CLAI在总体功能方面似乎有更好的疗效，且总体并发症可能更少。IB组疼痛复发率更低，石膏固定时间更短，恢复行走更快。
