Deltoid Ligament: Functional Analysis of the Medial Collateral Ligamentous Apparatus of the Ankle Joint

On 34 osteoligamentous ankle preparations the function of the various components of the deltoid ligament has been elucidated by tracing mobility patterns after successive transection of the components in varying sequence. The anterior and posterior talofibular ligaments were included in the study to investigate the interaction between these structures and the deltoid ligament. The tibiocalcaneal and the intermediate tibiotalar ligaments control abduction of the talus. The anterior tibiota-lar and talofibular ligaments control plantar flexion, while dorsiflexion is inhibited by the posterior tibiotalar and talofibular ligaments, and partly by the anterior talofibular ligament as well. In combination, the anterior and intermediate tibiotalar ligaments control external rotation, while the intermediate and posterior tibiotalar ligaments control both external and, together with the anterior talofibular ligament, internal rotation of the talus. Isolated, neither the anterior nor the posterior tibiotalar ligament appears to play any major role in ankle stability.     

人工LARS韧带在慢性踝关节外侧不稳定中的应用

目的 探讨人工LARS韧带在慢性踝关节外侧不稳定中的应用疗效。方法 回顾性分析北部战区总医院骨科2018年1月至2019年12月收治的30例慢性踝关节外侧不稳病例的临床资料,均为男性,年龄为（23.1±5.3）岁（18~27岁）,左踝19例,右踝11例。由同一位医生采用仰卧位全关节镜下行外踝Y形人工LARS韧带重建术。观察术后2周切口愈合情况,术前及术后12个月内翻应力位距骨倾斜角度。记录术前及末次随访时美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分系统、踝关节功能Kofoed评分、疼痛视觉模拟量表（visual analogue scale,VAS）评分。术后指导病例行相关康复锻炼。结果 病人随访时间为（12.6±1.7）个月（12~24个月）,全部病例踝关节切口愈合情况佳,无感染等并发症发生,术后恢复满意。AOFAS评分和Kofoed评分分别由术前（42.20±5.98）分、（66.17±3.31）分提升至术后（80.63±5.39）分、（81.60±4.35）分,VAS评分由术前（7.63±0.85）分降至术后（1.03±0.67）分,内翻应力位距骨倾斜角度由术前14.73°±1.46°缩小至术后12个月的2.83°±1.01°,差异均有统计学意义（P＜0.05）。术后各项康复锻炼均达到预期目标。结论 应用人工LARS韧带治疗慢性踝关节外侧不稳疗效满意,具有踝关节稳定性好,快速恢复运动等优点,有效避免下肢深静脉血栓形成及肌肉萎缩,值得在临床上推广。     

全镜下外踝韧带缝线增强修补术在训练伤致慢性踝关节不稳治疗中的应用

目的 探讨全镜下外踝韧带缝线增强修补术在军事训练伤所致慢性踝关节不稳治疗中应用的临床疗效。方法 回顾性分析2019年1月至2020年1月经中国人民解放军北部战区总医院诊治的42例慢性踝关节不稳病人的临床资料,男39例,女3例,其中左踝29例,右踝13例,年龄为（30.55±6.84）岁（19~43岁）。全部病例均于我院行关节镜下外踝韧带手术,手术方式采用缝线增强修补方案。记录病人术前和术后6、12个月的美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分、踝关节功能Karlsson评分、Tenger运动水平评分、疼痛视觉模拟量表（visual analogue scale,VAS）评分和术后不良反应发生情况。结果 病人随访时间为（13.16±3.22）个月,术后6、12个月AOFAS评分［（65.66±5.07）分、（72.87±4.23）分］、Karlsson评分［（71.46±6.53）分、（83.96±5.28）分］、Tenger评分［（6.14±1.01）分、（7.85±0.88）分］、VAS评分［（2.71±0.87）分、（1.68±0.70）分］均较术前［（52.87±6.24）分、（53.80±7.20）分、（4.15±0.91）分、（5.29±1.25）分］明显改善（P＜0.05）,随访期间病人未出现神经损伤、关节内感染、脱钉等严重不良反应。结论 关节镜下外踝韧带缝线增强修补术治疗慢性踝关节不稳的短期疗效满意且无严重不良反应,推荐临床中应用。     

Experimental Ankle Injuries: Analysis of the Traumatology of the Ankle Ligaments

On 32 osteoligamentous ankle preparations forced movements were performed in varying, accurately defined directions. the sequence in which this caused rupture of the individual ligamentous structures of the ankle is described. Dorsiflexion traumas predominantly injured the posterior part of the deltoid ligament, while in plantar flexion traumas the injuries primarily involved the anterior capsule and the anterior talofibular ligament. Internal rotation traumas injured the anterior talofibular ligament and the short, anterior fibres of the posterior talofibular ligament before the calcaneofibular ligament was damaged, whereas in adduction traumas the calcaneofibular ligament ruptured first. Forced external rotation primarily caused rupture of the deep structures of the deltoid ligament, while conversely abduction traumas first caused rupture of the superficial part of this ligament.     

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

Background

Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability.

Methods

MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study.

Results

Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%.

Conclusions

MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.