手术治疗慢性踝关节外侧不稳106例

目的探讨慢性踝关节外侧不稳继发病损及其有效的手术方法。方法 本组行手术解剖重建外踝韧带治疗慢性踝关节外侧不稳的患者106例,观察其继发病损在关节镜下的表现。结果 对本组患者随访12～111个月,平均31.2个月,术后所有踝关节均达到功能稳定,关节活动度基本恢复正常,没有复发性踝关节不稳发生。运用美国AOFAS足踝评分系统对患者手术前后踝关节功能进行评估,术前与术后AOFAS后足评分间的差异有统计学意义。结论 解剖重建距腓前韧带、跟腓韧带,有效地矫正了踝关节外侧不稳定和距下关节不稳定,是治疗踝关节慢性前外侧严重不稳定的合理而有效的治疗方法。     

关节镜下清理联合外踝韧带修补治疗慢性踝关节外侧不稳

目的探讨关节镜下清理联合外踝韧带修补治疗慢性踝关节外侧不稳的临床疗效。方法陕西省榆林市中医医院骨二科在2014年4月至2017年7月,通过关节镜下清理结合外踝韧带修补治疗慢性踝关节外侧不稳24例,术后制动6周,定期随访,末次随访运用美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)足踝评分系统、距骨前移距离、距骨倾斜角进行评估。结果 24例患者,2例失访,平均随访11.4个月。末次随访踝关节肿痛、不稳等症状消失,前抽屉试验(-),内翻应力试验(-),AOFAS评分较术前明显改善,平均(92.01±3.61)分,距骨前移距离较术前明显减少,平均为(3.18±1.61)mm,距骨倾斜角较术前明显变小,平均(4.64±1.61)°。结论关节镜下清理联合外侧韧带修补是治疗慢性踝关节外侧不稳的一种非常好的手术方式。     

距腓前韧带重建联合踝关节镜术治疗慢性踝关节外侧不稳

[目的]介绍用第三腓骨肌腱转位解剖重建距腓前韧带联合踝关节镜下微骨折术治疗慢性踝关节外侧不稳合并距骨骨软骨损伤的手术技术。[方法] 2015年12月～2017年5月25例(25踝)慢性踝关节外侧不稳合并距骨软骨损伤患者行手术治疗,所有患者均采取第三腓骨肌腱转位解剖重建距腓前韧带,踝关节镜下微骨折术治疗距骨骨软骨损伤。记录术后切口愈合情况及并发症发生情况,采用疼痛视觉模拟评分(VAS)评价踝关节疼痛程度,采用美国足踝外科协会后足与踝关节评分(AOFAS HA score)评价踝关节功能,并行影像评估。[结果]所有患者术后切口I期愈合,无神经损伤等并发症发生,术后均获得随访,随访时间12～30个月,平均(17.53±5.24)个月。末次随访时踝关节MRI显示重建距腓前韧带良好,修复的距骨软骨均较术前影像改善,VAS由术前的(4.15±0.93)分降低至术后的(0.99±0.80)分,AOFAS HA评分由术前的(55.60±4.21)分提高至末次随访时的(90.32±7.62)分,差异均具有统计学意义(P0.05)。[结论]应用第三腓骨肌腱转位解剖重建距腓前韧带联合踝关节镜下微骨折术治疗慢性踝关节外侧不稳合并距骨骨软骨损伤创伤小、并发症少、效果确切。     

双束股薄肌重建距腓前韧带治疗踝关节不稳

目的探讨双束股薄肌重建距腓前韧带治疗踝关节不稳的临床疗效。方法回顾性分析2017年1月至2018年10月南部战区总医院收治的21例踝关节不稳患者的临床资料,患者均采用双束股薄肌重建距腓前韧带。根据美国骨科足踝外科协会(AOFAS)评分评估患者手术前后踝关节功能,运用视觉模拟量表(VAS)评分观察术后疼痛症状改善情况。结果 21例患者均获得随访,平均随访时间(14.0±1.5)个月(12～18个月)。患者术后6个月和末次随访AOFAS评分、VAS评分均优于术前,手术前后比较,差异有统计学意义(P 0.05)。随访期间无伤口感染、韧带再次断裂、踝关节不稳复发或二次手术病例。1例患者术后3个月踝关节活动稍受限,1例术后6个月仍有踝关节疼痛,后期均恢复正常。结论应用双束股薄肌重建距腓前韧带是治疗踝关节不稳较好的术式选择,短期疗效满意。     

关节镜下关节囊皱缩术治疗慢性踝关节不稳的临床观察

目的对关节镜下关节囊皱缩术治疗慢性踝关节不稳进行临床观察。方法回顾性分析至本院就诊的90例慢性踝关节不稳患者,其中行传统第三腓骨肌重建韧带治疗距腓前韧带术患者作为对照组(n=47),行关节镜下关节囊皱缩术患者作为观察组(n=43)。比较两组患者踝关节功能状态、视觉模拟(VAS)评分、美国足踝骨科协会(AOFAS)评分及满意度调查情况。结果术后12周,两组距骨倾斜角、距骨前移距离、VAS评分较术前均显著下调,AOFAS评分较术前显著上调,且观察组上述指标及总满意度较对照组改善程度更为显著(P0.05)。结论关节镜下关节囊皱缩术治疗踝关节不稳患者,可有效增强患者术后踝关节稳定性,减轻患者疼痛,患者依从性高,具有临床推广价值。     

关节镜下治疗踝关节不稳伴前方撞击综合征

目的探讨踝关节不稳伴前方撞击综合征的原因及关节镜下治疗效果。方法回顾分析2013年1月至2015年12月20例踝关节不稳伴前方撞击综合征采用关节镜治疗的患者,所有患者均行关节腔滑膜清理,清除撞击组织,磨除骨赘,自体或异体腘绳肌肌腱重建距腓前韧带及跟腓韧带。术后石膏固定3周,同时实施康复计划。采用美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)评分、Karlsson踝关节功能评分(Karlssonankel function score,KAFS)、Tegner评分、前抽屉试验、踝关节活动度检查,以及术后MRI表现对疗效进行评估。结果 20例患者获得术后随访,随访时间6～24个月,平均(13.3±4.7)个月。镜下发现所有踝关节不稳的患者存在前方撞击表现:滑膜增生肥厚撞击2例,下胫腓前韧带撕裂撞击3例,距腓前韧带损伤后形成撞击6例,距骨骨性撞击5例,胫骨前唇增生撞击4例。AOFAS评分由术前(63.8±6.8)分提高到末次随访时(87.9±4.1)分,KAFS评分由术前(56.5±7.1)分提高到末次随访时(90.8±5.7)分,Tegner评分由术前(3.8±0.8)分提高到末次随访时(5.9±0.9)分,踝关节活动度由术前(51.2±6.2)°提高到末次随访时(67.2±4.6)°,踝关节背伸角度由术前(10.1±3.0)°提高到末次随访时(23.1±3.5)°,手术前后比较差异具有统计学意义(P0.05)。踝关节跖屈角度术前(41.1±4.8)°,末次随访时为(44.2±5.7)°,差异无统计学意义(P0.05)。结论踝关节损伤后发生踝关节不稳,是导致前方撞击发生的重要原因,是一种代偿性保护机制,关节镜下明确诊断后经过清除撞击物,可以明显提高踝关节背伸活动度,重建踝关节外侧韧带,提高踝关节的稳定性,达到很好的临床效果。     

手术治疗慢性踝关节外侧不稳106例

目的 探讨慢性踝关节外侧不稳继发病损及其有效的手术方法.方法 本组行手术解剖重建外踝韧带治疗慢性踝关节外侧不稳的患者106例,观察其继发病损在关节镜下的表现.结果 对本组患者随访12～111个月,平均31.2个月,术后所有踝关节均达到功能稳定,关节活动度基本恢复正常,没有复发性踝关节不稳发生.运用美国AOFAS足踝评分...     

踝关节镜前后联合入路治疗踝关节撞击综合征

目的 :分析踝关节镜前后联合入路对踝关节撞击综合症患者镜下行清理的临床疗效及术中注意事项。方法:回顾性分析自2011年4月至2015年4月采用踝关节镜治疗并获得完整随访的17例踝关节撞击综合症患者,其中男12例,女5例;手术时年龄22~47岁,平均32.4岁。结合患者临床症状和影像学评估予踝关节镜清理,并去除引起症状的撞击部位,术后常规予非甾体消炎药和关节内注射透明质酸钠治疗。采用AOFAS(美国足踝外科协会)后足-踝评分,Ogilvie-Harris踝关节评分对术前情况及术后末次随访情况进行评分。结果:17例手术中情况:关节镜下显示前外踝撞击征8例,前内踝撞击征2例,前踝撞击征2例,后踝撞击征2例,3例为同时合并前后踝撞击。术中清除增生的骨赘,引起撞击的下胫腓前韧带远侧束,距腓前韧带,滑膜组织和疤痕组织。4例同时合并关节软骨损伤,软骨损伤面积约1 mm×3 mm至1.5 mm×4 mm大小。术中同时采用直径1.2 mm的克氏针行钻孔微骨折处理。17例术后随访时间8~24个月,平均14.3个月。AOFAS评分由手术前的62.30±5.20增加至术后的87.60±5.40。Ogilvie-Harris踝关节评分由手术前的6.70±0.98增加至术后的12.80±1.21。术后患者均无神经血管损伤,无伤口感染,愈合不良等并发症。患者有不同程度的踝关节肿胀,于术后4~8周逐步消失。结论:对踝关节撞击综合症患者,前后联合入路可以有效清除引起踝关节撞击的骨性撞击和软组织撞击,结合术后非甾体消炎药和关节内注射透明质酸钠治疗,可以有效缓解踝痛症状,达到较好的治疗效果。     

伴有慢性踝关节外侧不稳的腓下骨的诊疗

目的探讨伴有慢性踝关节外侧不稳的腓下骨的临床诊断及治疗。方法回顾性分析自2008年9月至2017年11月我科收治的慢性踝关节外侧不稳的腓下骨患者13例13足,其中男4例,女9例;年龄18～40岁,平均(30.38±6.06)岁;腓下骨最大平均直径(8.38±3.07)mm。其中7例患者采用腓下骨切除术及距腓前韧带修复术,6例患者采用腓下骨内固定融合术及距腓前韧带修复术。术后定期随访,比较患者术前和末次随访时美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)的踝-后足评分。结果术后全部患者随访12～18个月,平均(14.31±2.50)个月,手术切口均甲级愈合;随访患者均达到骨性愈合标准,至末次随访时患者均未复发踝关节不稳症状。末次随访时7例行切除术患者的AOFAS评分平均为(90.00±1.63)分,6例行融合术患者的AOFAS评分平均为(90.50±2.59)分,分别与术前进行比较,差异均具有统计学意义(P0.05)。末次随访时,优9例,良4例,优良率100%。结论当腓下骨较大时(≥10 mm)采用内固定融合术及距腓前韧带修复术,腓下骨较小时(10 mm),可采用切除术及距腓前韧带修复术。     

半股腓骨短肌腱重建距腓前韧带治疗慢性外踝不稳的疗效分析

目的探讨慢性外踝不稳采用半股腓骨短肌腱重建的早期临床疗效。方法分析自2013年7月至2014年8月采用半股腓骨短肌腱解剖重建治疗25例慢性外踝不稳的临床资料,男13例,女12例;年龄25~54岁,平均(30.5±6.9)岁。术前均摄MRI检查且前抽屉试验阳性,确认距腓前韧带和跟腓韧带断裂或松弛。末次随访时采用踝关节评分。未出现术中骨折、切口感染、皮肤坏死及神经损伤等并发症。karlsson评分和美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)评分系统进行评价。结果术后切口均一期愈合,25例均获得随访13~29个月,平均(19.5±3.7)个月。Karlsson评分和AOFAS评分较术前均明显升高,踝关节功能明显改善。结论半股腓骨短肌腱解剖重建距腓前韧带具有创伤小、操作简单、踝关节功能恢复满意等优点。     

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

Background

Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions.

Methods

Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated.

Results

Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had ''tram-track'' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions.

Conclusions

Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients'' residual symptoms and significantly increased patient satisfaction.     

MRI appearance of the lateral fibulotalocalcaneal ligament complex injury in the patients with chronic lateral ankle instability

BackgroundThe anterior talofibular ligament (ATFL) comprises the superior and inferior fascicles. The inferior fascicle is connected to the calcaneofibular ligament, and forms “lateral fibulotalocalcaneal ligament (LFTCL) complex”. This study aimed to evaluate the feasibility of diagnosing LFTCL complex injuries in patients with chronic lateral ankle instability (CLAI).MethodsForty-eight ankles (35 with CLAI and 13 without CLAI) underwent arthroscopic surgery, and preoperative magnetic resonance imaging (MRI) was conducted with 0.8 mm- thick axial and oblique slices. The diagnostic accuracy of injuries to the superior fascicle and LFTCL complex was evaluated by two observers.ResultsThe sensitivity and specificity of the LFTCL complex injury were 94.7% and 92.3% for observer 1 and 84.2% and 84.6% for observer 2, respectively.ConclusionsMRI with 0.8 mm slices could detect LFTCL complex injury in patients with CLAI. Diagnosing the LFTCL complex injury on MRI will improve outcomes of an arthroscopic isolated ATFL repair.     

带线锚钉加强带结合改良Broström重建术修复距腓前韧带的疗效分析

目的 探讨和评价带线锚钉加强带结合改良Brostr?m重建术修复距腓前韧带(anterior talofibular ligament,ATFL)断裂所造成的慢性踝关节外侧不稳的方法和疗效.方法 回顾性分析2014年6月至2015年6月我院采用带线锚钉加强带结合改良Brostr?m重建术修复因ATFL断裂造成慢性踝关节不稳13例患者资料,男7例,女6例;年龄为17~32岁,平均为(25.50±4.37)岁.均有踝关节外侧轻度疼痛、反复扭伤病史和6个月以上的陈旧性损伤.术后1周在踝关节支具保护下行早期功能锻炼,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分系统对手术前后踝关节功能进行评估.结果 所有患者术后均获得随访,随访时间为3~12个月,平均为6个月.术后末次随访AOFAS踝-后足评分平均为(90.54±3.28)分较术前的(62.00±4.47)分明显改善,差异有统计学意义(P<0.05).结论 应用带线锚钉加强带技术结合改良Brostr?m重建术修复踝关节ATFL,可增强踝关节稳定性,结合早期功能锻炼,改善踝关节功能,达到理想的治疗效果.     

Rekonstruktion des Au?enbandapparats mittels Kniebeugesehnentransplantat bei chronischer Au?enbandinstabilit?t des OSG

Objective

Reconstruction of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligament in patients with chronic lateral ankle instability.

Indications

Symptomatic chronic lateral ankle instability.

Contraindications

Bony malalignment, advanced arthritic changes of the ankle joint, diabetic foot syndrome.

Surgical technique

Reconstruction of the ATFL and CFL with a free gracilisor or semitendinosus tendon graft through a V-shaped tunnel at the insertion site of the ATFL on the talar neck as well as a transfibular tunnel directed anterior to posterior through the fibula tip to a blind ending tunnel in the calcaneus at the insertion site of the CFL. Insertion of the graft through the talar tunnel, passing both graft ends through the fibular tunnel to the calcaneus. Fixation with a bioabsorbable screw.

Postoperative management

Short leg cast for 10?C14?days and partial weight-bearing. Afterwards ankle brace for 6?weeks and functional physical therapy.

Results

From December 2003 to August 2005, reconstruction of the ATFL and CFL with a hamstring tendon autograft was performed in 20 patients with chronic lateral instability of the ankle joint. All patients were evaluated after a mean follow-up time of 1.8?years (15?C36?months). Clinical evaluation referred to the AOFAS score. Stress radiography was performed for objective assessment of lateral ankle stability. Postoperatively 19 of 20 patients reported good subjective stability with no further ankle sprains. The mean postoperative AOFAS score was 92 of 100 points (72?C100). Stress radiography showed a significant reduction of both lateral ankle instability and talar tilt.     

经皮踝外侧韧带复合体重建治疗慢性踝外侧不稳

[目的]探讨经皮功能重建踝关节外侧韧带复合体治疗慢性踝关节不稳的临床疗效。[方法]2014年1月~2018年2月,符合纳入标准的47例慢性踝关节不稳患者随机分为两组,其中,切开组23例采用常规切开术式重建距腓前韧带(ATFL)和跟腓韧带(CFL),经皮组24例采用超声定位,经皮建立骨隧道重建ATFL和CFL。比较两组间手术时间、围术期并发症、踝背伸-跖屈活动度(ROM)、AOFAS评分、VAS评分,应力位影像测量距骨前移度和倾斜度。[结果]术中切开组2例出现腓浅神经损伤。经皮组手术时间、切口总长度显著小于切开组,差异有统计学意义(P<0.001)。切开组术后4例切口边缘处坏死,而经皮组1例切口渗液。两组患者随访26~30个月,平均(27.39±2.51)个月。术后6个月时,经皮组ROM显著大于切开组(P<0.05)。随时间推移两组患者AOFAS评分均显著增加,而VAS评分显著减少(P<0.001),但是两组相同时间点AOFAS评分和VAS评分的差异均无统计学意义(P>0.05)。应力位X线测量方面,术后两组患者距骨前移距度和距骨倾斜角均较术前显著减少(P<0.001)。但是两组相同时间点在距骨前移距度和距骨倾斜角的差异均无统计学意义(P>0.05)。[结论]经皮踝关节外侧韧带复合体重建治疗慢性踝关节不稳的效果与常规开放手术相当,但具有手术时间短、创伤小、并发症少的优点。     

踝关节镜下修复距腓前韧带治疗慢性踝关节不稳

目的探讨踝关节镜下改良Brostr?m法解剖修复距腓前韧带(ATFL)治疗慢性踝关节不稳的临床疗效。 方法选取2015年12月至2017年1月慢性踝关节不稳患者共12例,均采用踝关节镜辅助下改良Brostr?m法解剖修复距腓前韧带进行治疗。采用美国足踝外科学会(AOFAS)评分标准、Tegner运动水平评分及距骨倾斜角变化对手术前后疗效进行评价,随访观察并发症发生情况。治疗前后各观察指标比较采用配对t检验。 结果12例均获得15～46个月随访,平均(26±8)个月。随访期间,所有患者踝关节活动度基本达到正常水平,未出现踝关节不稳,无踝关节肿胀、疼痛等表现,末次随访AOFAS评分为(91.0±2.6)分、Tegner评分为(6.0±1.2)分,两者较术前均明显提高(t ＝10.57、12.38,均为P<0.001)。距骨倾斜角(4.5±1.0)°较术前降低(t＝7.13,P<0.001)。 结论踝关节镜下改良Brostr?m法解剖重建ATFL治疗慢性踝关节不稳,能更精准地探查韧带断端、定位韧带附着点、创伤小、疼痛轻、术后恢复快,疗效理想。     

关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带

目的 探讨关节镜下自体半腱肌肌腱重建踝关节外侧副韧带治疗慢性踝关节不稳定的方法及初期临床疗效。方法 将2015年12月至2017年2月我院收治的16例慢性踝关节不稳定病人纳入研究,其中男14例,女2例,年龄为（28.1±6.4）岁;术前应力位X线片提示距骨倾斜25.5°±5.5°（18°~35°）,距骨前移（10.1±1.8） mm（7~14 mm）。采用2.7 mm 30°短踝关节镜经前外侧入路观察,经前外侧辅助入路于腓骨远端和距骨外侧面距腓前韧带足印区制作骨隧道,跟骨外侧壁跟腓韧带止点处经皮透视制作骨隧道,取自体半腱肌肌腱对折编织成“Y”型,将移植物引入骨隧道,腓骨端使用袢钢板悬吊固定,距骨及跟骨端使用5.0 mm界面螺钉固定。术后早期功能锻炼,末次随访应用美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统评价踝关节功能;采用疼痛视觉模拟量表（visual analogue scale, VAS）评估疼痛情况;采用Sefton外侧副韧带重建疗效评价系统评估踝关节稳定性。结果 本组16例病人术后随访（16.8±4.3）个月（12~24个月）,均于术后3个月恢复正常体育活动,末次随访未观察到踝关节不稳定复发。AOFAS评分为（89.2±4.8）分,VAS评分为（0.7±0.6）分。依据Sefton评价标准：优9例,良5例,可2例,优良率为87.5%。结论 关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带治疗慢性踝关节不稳定的近期疗效理想,并发症较少。     

Safe angles of ATFL and CFL anchor insertion into anatomical attachment of fibula in a lateral ankle ligament repair

BackgroundLateral ankle ligament repair for chronic lateral ankle instability is common, and arthroscopic repair of the anterior talofibular ligament (ATFL) has been widely performed. However, it is desirable to repair of calcaneofibular ligament (CFL) combined with arthroscopic ATFL repair to obtain good long term clinical outcomes. Repairing CFL through small skin incision, there is the possibility to interfere with ATFL and CFL anchors because of close attachment of ATFL and CFL at fibula. The purpose of this study is to determine the safety anchor insertion angles for ATFL and CFL on CT images and to achieve ATFL and CFL repair with minimally invasive technique.MethodsFifty ankles in 50 patients were included in this study. On a sagittal CT image, the anchor drill hole angles for ATFL and CFL were measured to avoid interference with these anchors. Then, arthroscopic ATFL repair combined with CFL repair was performed on 15 patients according to the safety insertion angles obtained by CT. CFL repair was performed through 1.5 cm length of accessory anterolateral portal. Clinical outcome was evaluated using the Japanese Society for the Surgery of the Foot (JSSF) ankle hindfoot scale and the Karlsson score before surgery and at final follow-up.ResultsOn the CT image, the mean angles between the ATFL drill hole and anterior border of the fibula was 59.4 ± 6.5°, and those between the longitudinal axis of the fibula and ATFL drill hole, and the CFL drill hole were 34.6 ± 5.0°, and 15.1 ± 5.7°, respectively. Postoperative CT after arthroscopic ATFL repair combined with CFL repair showed that no interference with 2 anchors, and JSSF scale and the Karlsson score were significantly improved from preoperative to final follow-up.ConclusionsThis study showed how safety ATFL and CFL anchor insertion angles comprise a minimally invasive anatomical repair technique.     

Investigation of Factors Affecting the Clinical Results of Arthroscopic Anterior Talofibular Ligament Repair for Chronic Lateral Ankle Instability

This study aimed to examine the factors affecting the clinical outcomes of anterior talofibular ligament (ATFL) repair surgery with arthroscopy for chronic lateral ankle instability (CLAI). From 2015 to 2018, 18 consecutive patients diagnosed with CLAI after conservative treatment for ≥3 months underwent arthroscopic ATFL repair surgery using the Broström-Gould technique. Clinical scores at 1 year postoperatively on the Karlsson scoring scale (median, 85 points) and the Japanese Society for Surgery of the Foot scale (median, 90 points) were significantly improved compared with preoperative scores (median, 50 and 66 points; p < .001 and <.001, respectively). The median period to start jogging was 2 and 6 months for patients without (n = 11) and with (n = 7) cartilage damage, respectively, showing a significant difference (p = .006). Four patients with cartilage damage could not return to preinjury sports within 1 year after surgery. In the stress radiographs, the talar tilt angle (TTA) significantly improved from a median of 6° preoperatively to a median of 3.5° postoperatively (p = .002). Talar anterior drawer distance (TAD) significantly improved from a median of 6.5 mm preoperatively to a median of 4.1 mm postoperatively (p < .001). There was no significant difference in TTA or TAD between patients without and with cartilage damage. The period to start jogging postoperatively was significantly correlated with postoperative TTA and TAD. It is suggested that the postoperative period to start activities was delayed because of the larger postoperative TTA and TAD. According to our results, the postoperative period to start activities may depend on cartilage damage and instability remaining postoperatively.