Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA.
Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2024 Sep;32(9):2452-2462. doi: 10.1002/ksa.12360. Epub 2024 Jul 21.
The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament.
Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data.
Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament.
This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs.
Level IV, Retrospective case series.
本回顾性研究的目的是确定伴有前胫腓韧带远侧纤维束肥厚的前踝撞击症患者中，外侧距骨穹窿骨软骨病变（OCL）的发生率。
回顾性病历分析确定了 40 名接受前踝关节镜治疗前踝撞击症的患者。评估的临床结果包括术前和术后足踝评分（FAOS）、视觉模拟评分（VAS）、并发症、失败、二次手术、重返工作和重返运动的数据。
32 名患者平均随访 29.3±10.4 个月。29 名患者（90.6%）的前胫腓韧带远侧纤维束肥厚，MRI 上平均厚度为 2.5±0.4mm。关节镜下发现 22 例（75.9%）外侧距骨穹窿 OCL 伴前胫腓韧带远侧纤维束肥厚。根据国际软骨修复协会（ICRS）分级，病变包括 3 例（13.6%）I 级病变、15 例（68.1%）II 级病变、3 例（13.6%）III 级病变和 1 例（4.6%）IV 级病变。FAOS 和 VAS 评分从术前到术后均有统计学显著改善（p<0.001）。在前胫腓韧带远侧纤维束切除后，未观察到联合不稳定。
本回顾性病例系列研究表明，前胫腓韧带远侧纤维束肥厚与关节镜评估时发现的外侧距骨穹窿 OCL 有关。此外，术前 MRI 对这些 OCL 的检测敏感性较差。在没有相关 OCL 的情况下，术前 MRI 显示前踝撞击症伴前胫腓韧带远侧纤维束肥厚的患者中，应提高对潜在外侧距骨穹窿 OCL 的认识。
IV 级，回顾性病例系列研究。
