Bai Lu, Liu Sanbiao, Tang Lubo, Guan Siyao, Xie Xiaoxiao, Zhang Xintao
Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China.
Department of Orthopaedics, The Fifth Hospital of Wuhan, The Second Hospital Affiliated of Jianghan University, Wuhan, Hubei, China.
Orthop J Sports Med. 2024 Oct 24;12(10):23259671241270309. doi: 10.1177/23259671241270309. eCollection 2024 Oct.
Anterior ankle bony impingement, which can cause pain and dysfunction of the ankle, is commonly seen in sports injuries. Its primary cause is repeated injury due to chronic ankle instability. An excellent clinical result has been reported by surgically removing osteophytes and ankle stabilization. However, reports of complex anterior impingement combined with lateral ankle instability are rare, which remains challenging in clinical practice.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the clinical outcomes of anterior ankle bony impingement combined with lateral ankle instability with surgical dissection of osteophytes and stabilization. It was hypothesized that complex ankle osteophytes with instability would achieve optimal clinical outcomes through surgical management.
Case series; Level of evidence, 4.
A total of 57 patients with complex ankle bony impingement combined with lateral instability treated with surgical dissection of complex osteophytes between September 2013 and January 2019 were enrolled in the study. The clinical outcomes were evaluated by visual analog scale (VAS) for pain score, American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and radiographic examination with a mean follow-up time of 39.6 months. Postoperative ankle function and complications were compared using the test and post hoc Tukey significant difference test.
The mean AOFAS score significantly increased at the 3-month, 1-year, and 2-year follow-ups compared with the preoperative condition ( = 10.57, = .0001). The mean Karlsson score after surgery also significantly improved at each follow-up time compared with the preoperative score ( = 12.93, = .0001). The preoperative VAS score significantly decreased at 3 months, 1 year, and 2 years postoperatively ( = 8.73, = .001). A significant improvement of mean dorsiflexion difference was observed at 3 months and 1 year compared with the preoperative condition, but it seemed to have regressed at the 2-year follow-up ( = 2.11, = .01). Tibial side recurrence was found in 9 cases, including 7 Scranton type 1 and 2 Scranton type 2. Talar side recurrence was also found in 3 of those cases.
Our retrospective study demonstrated that complex ankle bony impingement combined with lateral instability can yield good clinical results when treated surgically with both ankle stabilization and osteophyte removal.
前踝骨撞击症在运动损伤中较为常见，可导致踝关节疼痛和功能障碍。其主要原因是慢性踝关节不稳定导致的反复损伤。通过手术切除骨赘和稳定踝关节已报告有良好的临床效果。然而，关于复杂的前踝撞击合并外侧踝关节不稳定的报道很少，这在临床实践中仍然具有挑战性。
目的/假设：本研究的目的是评估通过手术切除骨赘和稳定踝关节来治疗前踝骨撞击合并外侧踝关节不稳定的临床效果。假设通过手术治疗，伴有不稳定的复杂踝关节骨赘将获得最佳临床效果。
病例系列；证据等级，4级。
本研究纳入了2013年9月至2019年1月期间共57例接受复杂骨赘手术切除治疗的复杂踝关节骨撞击合并外侧不稳定的患者。通过视觉模拟量表（VAS）疼痛评分、美国矫形足踝协会（AOFAS）评分、卡尔森评分以及影像学检查评估临床效果，平均随访时间为39.6个月。使用t检验和事后Tukey显著差异检验比较术后踝关节功能和并发症情况。
与术前相比，在3个月、1年和2年随访时，平均AOFAS评分显著提高（t = 10.57，P = .0001）。与术前评分相比，术后各随访时间的平均卡尔森评分也显著改善（t = 12.93，P = .0001）。术前VAS评分在术后3个月、1年和2年时显著降低（t = 8.73，P = .001）。与术前相比，在3个月和1年时观察到平均背屈差异有显著改善，但在2年随访时似乎有所恢复（t = 2.11，P = .01）。发现9例胫骨侧复发，包括7例斯克兰顿1型和2例斯克兰顿2型。其中3例还发现距骨侧复发。
我们的回顾性研究表明，对于复杂的踝关节骨撞击合并外侧不稳定，通过手术稳定踝关节并切除骨赘进行治疗可取得良好的临床效果。
