Kanemitsu Munekazu, Nakasa Tomoyuki, Ikuta Yasunari, Moriwaki Dan, Sakurai Satoru, Ishibashi Saori, Chujo Taro, Adachi Nobuo
Department of Orthopaedic Surgery, Matsuyama Red Cross Hospital, Matsuyama, JPN.
Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN.
Cureus. 2025 Jul 18;17(7):e88225. doi: 10.7759/cureus.88225. eCollection 2025 Jul.
The all-inside arthroscopic Broström procedure using suture anchors has gained popularity and yielded favorable clinical outcomes for chronic lateral ankle instability (CLAI). However, recurrent instability after surgery remains a significant concern, and one of the possible causes may be the loosening of the repaired ligament due to anchor dislocation or loosening by poor bone quality. The anchor insertion position for the anterior talofibular ligament (ATFL) is often proximal to its anatomical attachment because it is not fully observed under arthroscopy, and non-anatomical points may have poor bone quality. This study aimed to evaluate bone quality at anatomical and non-anatomical anchor insertion points in ATFL repair.
Forty-four ankles of 43 patients (21 men and 23 women; mean age 35.4 years) who underwent arthroscopic ATFL repair for CLAI were included. Anatomic attachment sites were identified using the fibular obscure tubercle (FOT) as an indicator. Hounsfield unit (HU) values were measured at the anatomical and proximal non-anatomical points of ATFL attachment at the fibula in preoperative computed tomography images and compared between these points.
The HU value at the anatomical point was significantly higher than that at the non-anatomical point in both coronal and sagittal images (P<0.05). No significant differences in HU values at anatomical and non-anatomical points were observed between sexes or in ATFL remnant quality. The HU value in the point proximal 0-2 mm from the anatomical attachment of the ATFL was significantly higher than in the point proximal 6-8 mm from the anatomical point. Weak negative correlations between HU values and age were observed at the point proximal 4-8 mm from the anatomical attachment of the ATFL.
Anchor insertion into the non-anatomical attachment at the fibular side has a potential risk of anchor loosening or dislocation due to poor bone quality. To prevent this, anchor insertion should be inserted within 4 mm proximal to the anatomical attachment of the ATFL.
使用缝线锚钉的全关节镜下布罗斯特罗姆手术已受到广泛关注，并在慢性外侧踝关节不稳（CLAI）的治疗中取得了良好的临床效果。然而，术后复发性不稳仍然是一个重大问题，其中一个可能的原因可能是由于锚钉脱位或骨质不佳导致修复韧带松动。由于在关节镜下无法完全观察到，距腓前韧带（ATFL）的锚钉插入位置通常在其解剖附着点的近端，而非解剖位置的骨质可能较差。本研究旨在评估ATFL修复中解剖和非解剖锚钉插入点的骨质。
纳入43例（21例男性和23例女性；平均年龄35.4岁）因CLAI接受关节镜下ATFL修复的患者的44个踝关节。以腓骨隐窝结节（FOT）为指标确定解剖附着点。在术前计算机断层扫描图像中测量腓骨上ATFL附着的解剖点和近端非解剖点的亨氏单位（HU）值，并比较这些点之间的差异。
在冠状位和矢状位图像中，解剖点的HU值均显著高于非解剖点（P<0.05）。在性别之间或ATFL残余质量方面，解剖点和非解剖点的HU值均未观察到显著差异。距ATFL解剖附着点近端0-2 mm处的HU值显著高于距解剖点近端6-8 mm处的HU值。在距ATFL解剖附着点近端4-8 mm处观察到HU值与年龄之间存在弱负相关。
在腓骨侧非解剖附着点插入锚钉存在因骨质不佳而导致锚钉松动或脱位的潜在风险。为防止这种情况，应在距ATFL解剖附着点近端4 mm以内插入锚钉。
