联合距腓前韧带（ATFL）和跟腓韧带（CFL）修复与单纯ATFL修复治疗重度慢性外侧踝关节不稳的比较疗效
Comparative effectiveness of combined ATFL and CFL repair versus ATFL-only repair for severe chronic lateral ankle instability.
作者信息
Yoshimoto Kensei, Noguchi Masahiko, Tominaga Ayako, Kumaki Mitsuki, Koseki Takumi, Okazaki Ken
机构信息
Department of Orthopedic Surgery Tokyo Women's Medical University Shinjuku-ku Tokyo Japan.
Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital Setagaya-ku Tokyo Japan.
出版信息
J Exp Orthop. 2025 Jul 13;12(3):e70345. doi: 10.1002/jeo2.70345. eCollection 2025 Jul.
PURPOSE
Repairing only the anterior talofibular ligament (ATFL) remnant in severe chronic lateral ankle instability (CLAI) with a concurrent calcaneofibular ligament (CFL) injury can result in persistent instability, highlighting the need to include CFL repair. Thus, this study aimed to examine the effectiveness of combined CFL and ATFL repair in severe CLAI with a concurrent CFL injury.
METHODS
Eighty ankles from 77 patients with severe CLAI with a concurrent CFL injury who underwent lateral ankle ligament repair were retrospectively examined. Severe CLAI with a concurrent CFL injury was defined as an ATFL that exhibited no mechanical resistance to hook palpation during arthroscopy. Among them, 39 ankles from 38 patients underwent arthroscopic ATFL repair between 2018 and 2021 (ATFL-only group), whereas 41 ankles from 39 patients underwent open ATFL and CFL repair between 2021 and 2024 (CFL-repair group). Outcomes included recurrent ankle instability (respraining of the operated ankle following surgery) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores.
RESULTS
No significant differences were observed between patient demographics in the two groups. Overall, 16 (41.0%) cases of recurrent ankle instability were observed in the ATFL-only group compared with 7 (17.1%) in the CFL-repair group, showing a significant difference ( = 0.026). No significant differences were found in the postoperative SAFE-Q scores between the two groups. Multivariate analysis adjusted for age, sex, body mass index, follow-up periods and sports participation revealed that ATFL-only repair was associated with a significantly higher risk of recurrent ankle instability compared with combined ATFL and CFL repair.
CONCLUSION
Although no significant difference was observed in postoperative SAFE-Q scores between the two groups, repairing ATFL along with CFL could be more effective in achieving stable ankle than ATFL-only repair for severe CLAI with a concurrent CFL injury.
LEVEL OF EVIDENCE
Level Ⅳ.
目的
在伴有跟腓韧带（CFL）损伤的重度慢性外侧踝关节不稳（CLAI）中，仅修复距腓前韧带（ATFL）残端可能导致持续性不稳，这凸显了同时进行CFL修复的必要性。因此，本研究旨在探讨CFL与ATFL联合修复在伴有CFL损伤的重度CLAI中的有效性。
方法
回顾性分析77例伴有CFL损伤的重度CLAI患者接受外侧踝关节韧带修复的80个踝关节。伴有CFL损伤的重度CLAI定义为关节镜检查时ATFL对钩状触诊无机械抵抗。其中，38例患者的39个踝关节在2018年至2021年期间接受了关节镜下ATFL修复（单纯ATFL组），而39例患者的41个踝关节在2021年至2024年期间接受了开放性ATFL和CFL修复（CFL修复组）。观察指标包括复发性踝关节不稳（术后患侧踝关节再次扭伤）和足部自我评估问卷（SAFE-Q）评分。
结果
两组患者的人口统计学特征无显著差异。总体而言，单纯ATFL组观察到16例（41.0%）复发性踝关节不稳，而CFL修复组为7例（17.1%），差异有统计学意义（P = 0.026）。两组术后SAFE-Q评分无显著差异。对年龄、性别、体重指数、随访时间和运动参与情况进行多因素分析后发现，与ATFL和CFL联合修复相比，单纯ATFL修复与复发性踝关节不稳的风险显著更高相关。
结论
虽然两组术后SAFE-Q评分无显著差异，但对于伴有CFL损伤的重度CLAI，与单纯ATFL修复相比，ATFL与CFL联合修复在实现踝关节稳定方面可能更有效。
证据级别
Ⅳ级。
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