距腓后韧带损伤在慢性踝关节外侧不稳定中的临床意义。
Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability.
机构信息
Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
出版信息
Arch Orthop Trauma Surg. 2024 Nov;144(11):5021-5030. doi: 10.1007/s00402-024-05598-7. Epub 2024 Sep 30.
PURPOSE
Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair.
MATERIALS AND METHODS
Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries.
RESULTS
The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries.
CONCLUSIONS
Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries.
EVIDENCE LEVEL
Level III.
目的
尽管关节镜下修复距腓前韧带（ATFL）已广泛应用，但距腓后韧带（PTFL）损伤对临床结果的影响仍不清楚。本研究旨在评估慢性外侧踝关节不稳定（CLAI）患者的 PTFL 的磁共振成像（MRI）表现，并确定 PTFL 损伤的存在与否是否会影响关节镜 ATFL 修复的术后结果。
材料与方法
本研究纳入了 35 例 40 侧因 CLAI 行关节镜修复术的患者作为实验组，另纳入 24 例无 CLAI 的 25 侧作为对照组。使用 MRI 测量 PTFL 厚度（PTFLT）和 PTFL 横截面积（PTFLCSA），并比较对照组和 CLAI 组之间的差异。比较合并和不合并 PTFL 损伤的踝关节的关节镜修复术的临床结果。
结果
CLAI 组的平均 PTFLT 和 PTFLCSA 值显著高于对照组。CLAI 组中，PTFL 损伤组的 PTFLT 和 PTFLCSA 值显著大于非损伤组。术后，合并和不合并 PTFL 损伤的踝关节在临床评分和应力位 X 线片上的距骨倾斜角方面均无显著差异；然而，PTFL 损伤组（32.1%）的踝关节较无 PTFL 损伤组（16.7%）更常出现不稳定复发。PTFL 损伤的踝关节常伴有质量较差的 ATFL 残端、ATFL 下束和跟腓韧带损伤。
结论
我们的研究结果表明，PTFL 损伤与 CLAI 密切相关，但不会影响术后临床评分。然而，PTFL 损伤的踝关节更常出现术后不稳定复发，这可能是因为它们常伴有质量较差的 ATFL 残端和 CFL 损伤。
证据等级
III 级。
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