Cho Byung-Ki, Kim Sung-Hoo, Choi Seung-Myung, Hwang Eun-Taek
Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
Foot Ankle Int. 2025 Jan;46(1):54-63. doi: 10.1177/10711007241291049. Epub 2024 Nov 19.
During the modified Broström procedure for chronic ankle instability, surgeons often experience cases with insufficiently restored mechanical stability even after anatomical ligament repair. In these cases, longer postoperative immobilization and delayed rehabilitation can be required, and a risk for recurrence of instability may persist. This study aimed to evaluate the clinical usefulness of suture-tape augmentation based on intraoperative stress radiographs during anatomical ligament repair for chronic ankle instability.
Twenty-four patients who underwent additional suture-tape reinforcement because of residual mechanical instability on intraoperative stress radiographs were followed up ≥3 years. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Changes in mechanical stability were analyzed through periodic stress radiographs, and postural control ability was evaluated with the modified Romberg test.
FAOS and FAAM scores improved significantly from preoperative mean 55.1 and 52.4 points to 92.3 and 90.2 points at final follow-up, respectively ( < .001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean 15.8 degrees and 13.6 mm to 2.9 degrees and 4.2 mm, respectively ( < .001). Balance retention time improved significantly from preoperative mean 3.6 to 6.4 seconds ( < .001). Although 9 patients experienced sprain injury after surgery, no patient showed recurrence of mechanical and subjective instability, and 21 patients (87.5%) were able to return to preinjury level of sports activity.
Evaluation of residual mechanical instability through intraoperative stress view and additional suture-tape augmentation showed satisfactory clinical outcomes at midterm follow-up. Suture-tape augmentation based on intraoperative stress radiographs seems to be a useful surgical option for patients with insufficiently restored mechanical stability even after anatomical ligament repair. This combined procedure can provide a reliable mechanical stability that can be performed after recognition of residual instability during the index surgery.
在慢性踝关节不稳的改良布罗斯特伦手术中，即使进行了解剖学韧带修复，外科医生仍常遇到机械稳定性恢复不足的情况。在这些病例中，可能需要更长时间的术后固定和延迟康复，并且不稳定复发的风险可能持续存在。本研究旨在评估在慢性踝关节不稳的解剖学韧带修复过程中，基于术中应力X线片的缝线带增强术的临床实用性。
对24例因术中应力X线片显示残留机械不稳定而接受额外缝线带加强的患者进行了≥3年的随访。使用足踝结局评分（FAOS）和足踝能力测量（FAAM）进行临床评估。通过定期应力X线片分析机械稳定性的变化，并用改良罗姆伯格试验评估姿势控制能力。
FAOS和FAAM评分从术前平均55.1分和52.4分分别显著提高到末次随访时的92.3分和90.2分（<0.001）。距骨倾斜角和距骨前移分别从术前平均15.8度和13.6毫米显著改善到2.9度和4.2毫米（<0.001）。平衡保持时间从术前平均3.6秒显著提高到6.4秒（<0.001）。虽然9例患者术后发生扭伤，但没有患者出现机械性和主观不稳定的复发，21例患者（87.5%）能够恢复到受伤前的体育活动水平。
通过术中应力视图评估残留机械不稳定并进行额外的缝线带增强术，在中期随访中显示出令人满意的临床结果。基于术中应力X线片的缝线带增强术似乎是一种有用的手术选择，适用于即使在解剖学韧带修复后机械稳定性恢复不足的患者。这种联合手术可以在初次手术中识别残留不稳定后提供可靠的机械稳定性。
