Won Sung Hun, Yi Young, Cho Jaeho, Lim Gyeong Hoon, Kim Hyun Seong, Song Ha Heon, Lee Sung Hyun
Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea.
Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Arthroscopy. 2025 May 8. doi: 10.1016/j.arthro.2025.04.032.
To evaluate the clinical outcomes of arthroscopic all-inside anterior talofibular ligament (ATFL) repair on the basis of the quality of the remnant ATFL.
We retrospectively analyzed consecutive patients with chronic ankle instability who underwent arthroscopic ATFL repair with a minimum follow-up period of 24 months. Patients were categorized into 2 groups on the basis of the arthroscopic ATFL grade: group G, characterized by good-to-moderate tissue quality with distension or ATFL discontinuity; and group P, characterized by poor tissue quality with a hypoplastic ATFL. Outcome measurements were obtained preoperatively and postoperatively. Patients-reported outcomes were assessed using the visual analog scale score, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score. Objective outcomes included posturographic analysis and radiologic evaluations, such as stress radiographs and axial view magnetic resonance imaging.
Both groups exhibited postoperative improvements in the subjective and objective clinical outcomes (all P < .05). For the sports unit of FAOS, 75.3% of group G exceeded the minimal clinically important difference threshold, compared with 57.8% of group P, showing a statistically significant difference (P = .027). Group P had significantly lower FAOS scores in the sports unit (group G: 86.9 ± 32.8, group P: 61.9 ± 26.4, P = .016), an increased fall risk as determined using posturography at the final follow-up (group G: 28.6 ± 22.4, group P: 49.7 ± 23.3, P = .019), and a greater retear rate on axial-view MRI (group G: 2.6%, 2/77, group P: 10.9%, 7/64, P = .044).
Arthroscopic all-inside ATFL repair is an effective treatment for chronic ankle instability, regardless of the quality of the remnant ligament. However, patients with poor ligament quality have inferior clinical outcomes, particularly in terms of sports-related activities, as reflected by both lower scores and fewer patients exceeding the minimal clinically important difference threshold. In addition, the fall risk index and retear rates were greater in patients with poor ligament quality, highlighting the impact of ligament quality on postoperative stability and functional recovery.
Level III, retrospective cohort study.
基于距腓前韧带（ATFL）残端的质量评估关节镜下全内置ATFL修复术的临床疗效。
我们回顾性分析了连续接受关节镜下ATFL修复术且随访期至少24个月的慢性踝关节不稳患者。根据关节镜下ATFL分级将患者分为两组：G组，其特征为组织质量良好至中等，伴有扩张或ATFL连续性中断；P组，其特征为组织质量差，ATFL发育不全。在术前和术后进行疗效评估。使用视觉模拟量表评分、足踝结局评分（FAOS）和卡尔松踝关节功能评分评估患者报告的结局。客观结局包括姿势分析和影像学评估，如应力X线片和轴位磁共振成像。
两组患者的主观和客观临床疗效均有术后改善（所有P <.05）。对于FAOS的运动单元，G组75.3%的患者超过了最小临床重要差异阈值，而P组为57.8%，差异有统计学意义（P =.027）。P组在运动单元的FAOS评分显著更低（G组：86.9±32.8，P组：61.9±26.4，P =.016），在末次随访时使用姿势分析确定的跌倒风险增加（G组：28.6±22.4，P组：49.7±23.3，P =.019），并且在轴位MRI上的再撕裂率更高（G组：2.6%，2/77，P组：10.9%，7/64，P =.044）。
关节镜下全内置ATFL修复术是治疗慢性踝关节不稳的有效方法，无论残端韧带的质量如何。然而，韧带质量差的患者临床疗效较差，尤其是在与运动相关的活动方面，这表现为得分更低且超过最小临床重要差异阈值的患者更少。此外，韧带质量差的患者跌倒风险指数和再撕裂率更高，突出了韧带质量对术后稳定性和功能恢复的影响。
III级，回顾性队列研究。
