Fu Ke, Jia Shenghong, Lin Shiwei, Xu Chenyu, Fang Zhenhua
Department of Foot and Ankle Surgery, Wuhan Fourth Hospital, Wuhan, China.
College of Sports Medicine, Wuhan Sports University, Wuhan, China.
Foot Ankle Int. 2025 Jan;46(1):92-101. doi: 10.1177/10711007241291051. Epub 2024 Nov 19.
Chronic syndesmotic instability (CSI) can be associated with severe long-term pain and disability. This study aimed to investigate the risk factors associated with the development of CSI in patients who underwent conservative treatment after the first episode of acute ankle sprain (AAS) that did not result in a satisfactory outcome.
We retrospectively analyzed the clinical data of patients who underwent ankle arthroscopy for suspected CSI between January 2020 and September 2023. The patients were divided into the instability and stability groups based on the syndesmotic space width measured under arthroscopy, with 3 mm as the critical value. Demographic, arthroscopic, and imaging information such as the anterior talofibular ligament (ATFL), calcaneofibular ligament, posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), deltoid ligament (DL), interosseous membrane, height of the syndesmotic fluid, injuries of the talus, calcaneus, tibia, and fibula, effusion of the tibiotalar and talocalcaneal joints, fibular morphology, and fibular incisura features, were recorded. Univariate and multivariate analyses were performed successively to identify the risk factors.
Of the 356 patients, 102 developed CSI after the first episode of AAS. In the multivariate analysis, development of CSI was associated with 5 clinical factors: DL injury (odds ratio [OR] 7.453, 95% CI 3.007-18.471; < .001), positive bandage-binding test (OR 7.196, 95% CI 2.942-17.599; < .001), grade 2 to 3 injury of the PITFL (OR 2.727, 95% CI 1.044-7.124; = .041), positive squeeze test (OR 2.455, 95% CI 1.045-5.770; = .039), and body mass index (BMI) (OR 1.306, 95% CI 1.121-1.522; < .001).
Five key factors were associated with CSI development in patients who underwent conservative treatment after the first episode of AAS that did not result in a satisfactory outcome: DL injury, positive bandage-binding test, grade 2 to 3 injury of the PITFL, positive squeeze test, and BMI.
慢性下胫腓联合不稳定（CSI）可能与严重的长期疼痛和功能障碍有关。本研究旨在调查首次急性踝关节扭伤（AAS）后接受保守治疗但效果不佳的患者发生CSI的相关危险因素。
我们回顾性分析了2020年1月至2023年9月间因疑似CSI接受踝关节镜检查的患者的临床资料。根据关节镜下测量的下胫腓联合间隙宽度将患者分为不稳定组和稳定组，临界值为3毫米。记录人口统计学、关节镜和影像学信息，如距腓前韧带（ATFL）、跟腓韧带、后距腓韧带（PTFL）、下胫腓前韧带（AITFL）、下胫腓后韧带（PITFL）、三角韧带（DL）、骨间膜、下胫腓联合液高度、距骨、跟骨、胫骨和腓骨损伤情况、胫距关节和距跟关节积液、腓骨形态以及腓骨切迹特征。先后进行单因素和多因素分析以确定危险因素。
356例患者中，102例在首次AAS后发生了CSI。在多因素分析中，CSI的发生与5个临床因素相关：DL损伤（比值比[OR]7.453，95%可信区间3.007 - 18.471；P <.001）、绷带捆绑试验阳性（OR 7.196，95%可信区间2.942 - 17.599；P <.001）、PITFL 2至3级损伤（OR 2.727，95%可信区间1.044 - 7.124；P = 0.041）、挤压试验阳性（OR 2.455，95%可信区间1.045 - 5.770；P = 0.039）以及体重指数（BMI）（OR 1.306，95%可信区间
