Foot and Ankle Unit, Casa di Cura Villa Montallegro, Genoa, Italy.
Department of Orthopaedic Surgery "Gruppo Policlinico Di Monza", Clinica Salus, Alessandria, Italy.
Knee Surg Sports Traumatol Arthrosc. 2024 Dec;32(12):3082-3089. doi: 10.1002/ksa.12164. Epub 2024 Apr 1.
Rotational ankle instability is a multiligamentous injury defined as an overload injury of the deltoid ligament caused by a long-standing injury of the lateral collateral ligament in patients affected by chronic ankle instability. The purpose of the study was to compare the clinical outcomes of combined arthroscopic repair of lateral and medial ankle ligaments for rotational ankle instability versus isolated arthroscopic lateral ligament repair for lateral ankle instability at 2 years' follow-up.
Between 2019 and 2021, 108 patients with chronic ankle instability were consecutively treated by arthroscopy. Of this group, 83 patients (77%) [median age: 26 (range, 14-77) years] underwent an isolated all-inside lateral ligament repair for lateral ankle instability (group A). In the remaining 25 patients (23%) [median age: 27 (range, 17-58) years], rotational ankle instability was clinically suspected and confirmed during arthroscopy; thus, a combined all-inside repair of lateral and medial ligaments was performed (group B). The same postoperative protocol was utilised for both groups. Patients were prospectively evaluated before surgery, at 3, 6, 12 and 24 months with Foot Functional Index (FFI) score, visual analogue scale (VAS) and Foot and Ankle Ability Measure-Sports subscale (FAAM-SS). At the latest follow-up, the satisfaction rate and complications were also recorded.
In both groups, FFI, VAS and FAAM-SS scores significantly improved compared to preoperative values (p < 0.001). In addition, according to all the scores evaluated, there was no significative difference (n.s) between groups at the final follow-up or at any of the intermediate follow-up. No major complications were observed in both groups.
Arthroscopic ligament repair in case of ankle multiligamentous injuries, such as in rotational ankle instability, provides excellent clinical outcomes and is comparable to isolated lateral ligament repair at 2 years' follow-up. Therefore, when treating ankle instability, arthroscopic repair of each and every ligament that appears injured provides the best potential outcomes and is the recommended treatment.
Level II, prospective comparative.
旋转性踝关节不稳定是一种多韧带损伤，定义为慢性踝关节不稳定患者中慢性外侧副韧带损伤引起的三角韧带超负荷损伤。本研究的目的是比较关节镜下修复外侧和内侧踝关节韧带治疗旋转性踝关节不稳定与单独关节镜下修复外侧踝关节不稳定在 2 年随访时的临床结果。
2019 年至 2021 年间，连续对 108 例慢性踝关节不稳定患者进行关节镜治疗。其中，83 例（77%）[中位数年龄：26（范围，14-77）岁]接受了外侧踝关节不稳的单纯全内外侧韧带修复（A 组）。在其余 25 例（23%）[中位数年龄：27（范围，17-58）岁]患者中，术中临床怀疑并确诊为旋转性踝关节不稳定；因此，行外侧和内侧韧带的全内修复（B 组）。两组均采用相同的术后方案。患者在术前、术后 3、6、12 和 24 个月时分别采用足部功能指数（FFI）评分、视觉模拟评分（VAS）和足部踝关节能力测量-运动亚量表（FAAM-SS）进行前瞻性评估。在末次随访时，还记录了满意度和并发症。
两组 FFI、VAS 和 FAAM-SS 评分均较术前显著改善（p<0.001）。此外，根据所有评估的评分，在最终随访或任何中间随访时，两组之间均无显著差异（n.s）。两组均未出现重大并发症。
关节镜下治疗踝关节多韧带损伤，如旋转性踝关节不稳定，可获得良好的临床效果，与 2 年随访时的单纯外侧韧带修复相当。因此，在治疗踝关节不稳定时，对每一条受伤的韧带进行关节镜修复可提供最佳的潜在效果，是推荐的治疗方法。
II 级，前瞻性比较。
