Vulcano Ettore, Marciano Gerard F, Pozzessere Enrico
Mount Sinai Medical Center, Columbia University, Miami, FL 33140, USA.
Department of Orthopedics, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA.
Diagnostics (Basel). 2024 Oct 9;14(19):2252. doi: 10.3390/diagnostics14192252.
BACKGROUND/OBJECTIVES: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes.
Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded.
A significant improvement ( < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness.
The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.
背景/目的：传统上，慢性外侧踝关节不稳的手术治疗采用开放技术。关节镜辅助和全关节镜技术因其取得了良好的临床效果而越来越受欢迎。然而，它们依赖于外科医生的关节镜技术和对关节镜解剖结构的熟悉程度。最近，一种无需关节镜辅助的微创经皮技术已被开发出来，该技术融合了关节镜的优点，如软组织损伤最小，而无需进行关节镜技术的额外要求。本研究的目的是描述慢性外侧踝关节不稳的微创经皮技术，并报告其临床结果。
54例无踝关节内病变的连续患者在单一机构由一名接受过 fellowship 培训的足踝外科医生采用经皮技术进行外侧韧带修复治疗慢性踝关节不稳。术前及最终随访时记录足部功能指数（FFI）评分。所有患者的随访时间至少为12个月。还记录了术后并发症和患者满意度。
与术前值相比，FFI 有显著改善（<0.001）（从55，标准差4.1，降至10，标准差1.9）。一名患者在术后2.5个月跌倒后需要返回手术室进行同种异体移植重建的开放翻修手术。没有其他并发症，包括感染或神经损伤。术后总体满意度为98.1%，一名患者因踝关节僵硬过度而不满意。
所描述的微创经皮 Brostrom 手术对于治疗无踝关节内病变的慢性外侧踝关节不稳是安全有效的。
