Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial ri...Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.展开更多
BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pat...BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.展开更多
Peroneal tendon and retinacular pathology contributes to chronic lateral ankle instability. The “gold standard” surgical treatment for chronic lateral ankle instability has been the Brostrom-Gould procedure with its...Peroneal tendon and retinacular pathology contributes to chronic lateral ankle instability. The “gold standard” surgical treatment for chronic lateral ankle instability has been the Brostrom-Gould procedure with its modifications. An ankle arthroscopy is an adjuvant procedure to address any intra-articular pathology. We review our results of two study groups. The first group underwent an ankle arthroscopy and a Brostrom-Gould procedure. The second group (triad) underwent an ankle arthroscopy, the Brostrom-Gould procedure and excision of low lying peroneal muscle belly with tightening of the inferior peroneal retinaculum. The triad technique was performed on 97 patients and results compared to 71 ankle arthroscopies with the Brostrom-Gould procedure. The patients were contacted at a mean follow-up time of 30 months for postoperative ACFAS scores, VAS scores, and overall satisfaction. Patients were also asked to report incidence of ankle sprain recurrence. The average postoperative ACFAS hindfoot and ankle score was 92 for the triad group and 89 for the arthroscopic debridement and Brostrom-Gould group. The average overall satisfaction was 98% in the triad group and 91% in the scope and Brostrom group. There were 4 (4.3%) recurrences in the triad group and 12 (17.6%) in the Brostrom-Gould with scope group. Each group had a similar incidence of wound healing complications. Peroneal tendon and retinacular pathology contributes to continued ankle instability and pain. We believe that the triad procedure is superior to the Brostrom-Gould procedure.展开更多
BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease tran...BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction.Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing.However,the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament.The visual analogue score(VAS),American Orthopaedic Foot and Ankle Society score(AOFAS score)and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTS A total of 22 patients(22 ankles)were followed up for a mean of 12 mo.All patients reported significant improvement compared to their preoperative status.The mean AOFAS score improved from 42.3±4.9 preoperatively to 90.4±6.7 postoperatively.The mean Karlsson score improved from 38.5±3.2 preoperatively to 90.1±7.8 postoperatively.The mean VAS score improved from 1.9±2.5 preoperatively to 0.8±1.7 postoperatively.CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.展开更多
Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop la...Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop landing activity in subjects with chronic ankle instability (CAI)compared to healthy subjects with no history of CAI.Methods:Ten healthy subjects and 10 subjects who had multiple ankle sprains participated in the study as the control and unstable subjects,respectively.The CAI subjects were age,body mass index and gender matched with the control subjects.The arch index and ankle functions of the subjects were measured in a subject screening session.During the biomechanical test session,participants performed five trials of drop landing from 0.6 m,wearing no brace ( NB),ElementTM brace and ASO brace.Simultaneous recording of three-dimensional kinematic (240 Hz)and GRF (1200 Hz) data were performed.Results:The CAI subjects had lower ankle functional survey scores.The arch index and deformity results showed greater arch deformity of ElementTM against a static load than in NB and ASO due to greater initial arch position held by the brace.CAI participants had greater eversion velocity than healthy coutrols.The ASO brace reduced the first peak vertical GRF whereas ElementTM increased 2nd peak vertical GRF.ElementTM brace reduced eversion range of motion (ROM) and peak eversion velocity compared to NB and ASO.In addition,ElementTM reduced dorsiflexion ROM and increased peak plantarflexion moment compared to NB and ASO.Conclusion:Results of static arch measurements and dynamic ankle motion suggest that the restrictions offered by both braces are in part due to more dorsiflexed ankle positions at contact,and higher initial arch position and stiffer ankle for ElementTM.展开更多
Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （M...Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （MG）, peroneus longus （PL）, and tibialis anterior （TA） muscles. Methods： Twelve recreational athletes performed five drop landings from an overhead bar of 30 cm height on to three surfaces： a flat surface, a 25° inversion surface, and a combined surface of 25° inversion and 25° plantarflexion. The kinematic variables and integrated EMG （IEMG） of the three muscles were assessed using a one-way repeated measures ANOVA and a 3 × 3 （surface × muscle） ANOVA, respectively （p 〈 0.05）. Results： The IEMG results showed a significant muscle by surface interaction. The flat surface induced higher TA activity than the two tilted surfaces. The inverted surface produced significantly higher inversion peak angle and velocity than the flat surface, but similar PL activity across the surfaces. The MG IEMG, ankle plantarflexion angle, and inversion range of motion were significantly higher for the combined surface compared to the inverted surface. Conclusion： These findings suggest that compared to the inversion surface, the combined plantarflexion and inversion surface seems to provide a more unstable surface condition for lateral ankle sprains during landing.展开更多
Objective To compare the efficacy of Tuina(Chinese therapeutic massage)plus physical agents and physical agents alone for lateral collateral ligament injury of ankle in gymnasts,and to explore the feasibility of Tuina...Objective To compare the efficacy of Tuina(Chinese therapeutic massage)plus physical agents and physical agents alone for lateral collateral ligament injury of ankle in gymnasts,and to explore the feasibility of Tuina for injury intervention in competitive athletes.Methods A total of 64 gymnasts with types Ⅰ-Ⅱ lateral collateral ligament injury of ankle were selected and divided into a control group and an observation group according to a full analysis set based on the intention-to-treat principle,with 32 cases in each group.Patients in the control group received ultrasound and microwave treatment,while those in the observation group received additional Tuina manipulations.The efficacy was evaluated by total effective rate,visual analog scale(VAS)score,and American Orthopedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AHS)score.Results The total effective rate was 96.9% in the observation group and 90.6% in the control group.There was no statistical difference in the total effective rate between the two groups(P>0.05).The markedly effective rate was 75.0% in the observation group and 46.9% in the control group.The markedly effective rate in the observation group was higher than that in the control group(P<0.05).After treatment,the VAS scores of both groups showed a downward trend,and there were statistical differences between different treatment time points in the same group(P<0.05).After one and three months of treatment,the VAS scores of the observation group were lower than those of the control group(P<0.05).There were statistical differences in the AOFAS-AHS score before and after treatment within the same group(P<0.05).After one month of treatment,there was no statistical difference in the AOFAS-AHS score between the two groups(P>0.05).After three months of treatment,the AOFAS-AHS score in the observation group was higher than that in the control group,indicating statistical significance(P<0.05).There was an interaction between time and group(P<0.05).Conclusion Tuina plus physical agents can improve the symptoms of lateral collateral ligament injury of ankle in gymnasts.This combined treatment is superior to physical agents alone in relieving pain and improving joint functions.Therefore,Tuina plus physical agents can be used as a treatment for lateral collateral ligament injury of ankle in gymnasts.展开更多
Purpose:To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese,and/or with demand for highly intensive sports,and/or with poo...Purpose:To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese,and/or with demand for highly intensive sports,and/or with poor-quality ligament remnants.Methods:A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament(ATFL)reconstruction with tensional remnant repair technique from January 2019 to August 2021.General data,including demographics,surgical time,and postoperative adverse events,were recorded.The American Orthopaedic Foot and Ankle Society score(AOFAS),foot and ankle ability measure(FAAM),visual analog scale(VAS),and anterior talar translation were measured preoperatively and at 6 weeks,3 months,and 2 years postoperatively.Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL.Data were analyzed using SPSS 19.0.F test was used to analyze the pre-and postoperative VAS,FAAM,and AOFAS scores.The significance was set at p<0.05.Results:There were 20 males and 10 females among the patients with a mean age of(30.71±5.81)years.The average surgical time was(40.21±8.59)min.No adverse events were observed after surgery.At 2 years postoperatively,the anterior talar translation test showed grade 0 laxity in all patients.VAS score significantly decreased from preoperatively to 6 weeks,3 months,and 2 years postoperatively(p<0.001).Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks,3 months,and 2 years postoperatively was statistically significant(p<0.001).At 3 months postoperatively,most patients(23/30)could return to their pre-injured activities of daily living status.At 2 years postoperatively,all patients were able to return to their pre-injured activities of daily living status,and almost every patient(18/19)who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal.The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL.Conclusion:The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation,and allowed early return to pre-injured activities,which could be a reliable option for patients with chronic lateral ankle instability.展开更多
基金supported by the Biomedicine Supporting Program of Shanghai "Science and Technology Innovation Plan" (19441902400)the Ningxia Hui Autonomous Region Key R&D program (2020BCH01001)+1 种基金the Shanghai "Science and Technology Innovation Action Plan" Domestic Science and Technology Cooperation Project (20025800200)the Clinical Research Program of Shanghai Municipal Health Commission (201940367)。
文摘Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.
文摘BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.
文摘Peroneal tendon and retinacular pathology contributes to chronic lateral ankle instability. The “gold standard” surgical treatment for chronic lateral ankle instability has been the Brostrom-Gould procedure with its modifications. An ankle arthroscopy is an adjuvant procedure to address any intra-articular pathology. We review our results of two study groups. The first group underwent an ankle arthroscopy and a Brostrom-Gould procedure. The second group (triad) underwent an ankle arthroscopy, the Brostrom-Gould procedure and excision of low lying peroneal muscle belly with tightening of the inferior peroneal retinaculum. The triad technique was performed on 97 patients and results compared to 71 ankle arthroscopies with the Brostrom-Gould procedure. The patients were contacted at a mean follow-up time of 30 months for postoperative ACFAS scores, VAS scores, and overall satisfaction. Patients were also asked to report incidence of ankle sprain recurrence. The average postoperative ACFAS hindfoot and ankle score was 92 for the triad group and 89 for the arthroscopic debridement and Brostrom-Gould group. The average overall satisfaction was 98% in the triad group and 91% in the scope and Brostrom group. There were 4 (4.3%) recurrences in the triad group and 12 (17.6%) in the Brostrom-Gould with scope group. Each group had a similar incidence of wound healing complications. Peroneal tendon and retinacular pathology contributes to continued ankle instability and pain. We believe that the triad procedure is superior to the Brostrom-Gould procedure.
文摘BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction.Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing.However,the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament.The visual analogue score(VAS),American Orthopaedic Foot and Ankle Society score(AOFAS score)and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTS A total of 22 patients(22 ankles)were followed up for a mean of 12 mo.All patients reported significant improvement compared to their preoperative status.The mean AOFAS score improved from 42.3±4.9 preoperatively to 90.4±6.7 postoperatively.The mean Karlsson score improved from 38.5±3.2 preoperatively to 90.1±7.8 postoperatively.The mean VAS score improved from 1.9±2.5 preoperatively to 0.8±1.7 postoperatively.CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
基金supported in part by DeRoyal Industries, Inc.,Powell,TN,USA
文摘Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop landing activity in subjects with chronic ankle instability (CAI)compared to healthy subjects with no history of CAI.Methods:Ten healthy subjects and 10 subjects who had multiple ankle sprains participated in the study as the control and unstable subjects,respectively.The CAI subjects were age,body mass index and gender matched with the control subjects.The arch index and ankle functions of the subjects were measured in a subject screening session.During the biomechanical test session,participants performed five trials of drop landing from 0.6 m,wearing no brace ( NB),ElementTM brace and ASO brace.Simultaneous recording of three-dimensional kinematic (240 Hz)and GRF (1200 Hz) data were performed.Results:The CAI subjects had lower ankle functional survey scores.The arch index and deformity results showed greater arch deformity of ElementTM against a static load than in NB and ASO due to greater initial arch position held by the brace.CAI participants had greater eversion velocity than healthy coutrols.The ASO brace reduced the first peak vertical GRF whereas ElementTM increased 2nd peak vertical GRF.ElementTM brace reduced eversion range of motion (ROM) and peak eversion velocity compared to NB and ASO.In addition,ElementTM reduced dorsiflexion ROM and increased peak plantarflexion moment compared to NB and ASO.Conclusion:Results of static arch measurements and dynamic ankle motion suggest that the restrictions offered by both braces are in part due to more dorsiflexed ankle positions at contact,and higher initial arch position and stiffer ankle for ElementTM.
文摘Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （MG）, peroneus longus （PL）, and tibialis anterior （TA） muscles. Methods： Twelve recreational athletes performed five drop landings from an overhead bar of 30 cm height on to three surfaces： a flat surface, a 25° inversion surface, and a combined surface of 25° inversion and 25° plantarflexion. The kinematic variables and integrated EMG （IEMG） of the three muscles were assessed using a one-way repeated measures ANOVA and a 3 × 3 （surface × muscle） ANOVA, respectively （p 〈 0.05）. Results： The IEMG results showed a significant muscle by surface interaction. The flat surface induced higher TA activity than the two tilted surfaces. The inverted surface produced significantly higher inversion peak angle and velocity than the flat surface, but similar PL activity across the surfaces. The MG IEMG, ankle plantarflexion angle, and inversion range of motion were significantly higher for the combined surface compared to the inverted surface. Conclusion： These findings suggest that compared to the inversion surface, the combined plantarflexion and inversion surface seems to provide a more unstable surface condition for lateral ankle sprains during landing.
文摘Objective To compare the efficacy of Tuina(Chinese therapeutic massage)plus physical agents and physical agents alone for lateral collateral ligament injury of ankle in gymnasts,and to explore the feasibility of Tuina for injury intervention in competitive athletes.Methods A total of 64 gymnasts with types Ⅰ-Ⅱ lateral collateral ligament injury of ankle were selected and divided into a control group and an observation group according to a full analysis set based on the intention-to-treat principle,with 32 cases in each group.Patients in the control group received ultrasound and microwave treatment,while those in the observation group received additional Tuina manipulations.The efficacy was evaluated by total effective rate,visual analog scale(VAS)score,and American Orthopedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AHS)score.Results The total effective rate was 96.9% in the observation group and 90.6% in the control group.There was no statistical difference in the total effective rate between the two groups(P>0.05).The markedly effective rate was 75.0% in the observation group and 46.9% in the control group.The markedly effective rate in the observation group was higher than that in the control group(P<0.05).After treatment,the VAS scores of both groups showed a downward trend,and there were statistical differences between different treatment time points in the same group(P<0.05).After one and three months of treatment,the VAS scores of the observation group were lower than those of the control group(P<0.05).There were statistical differences in the AOFAS-AHS score before and after treatment within the same group(P<0.05).After one month of treatment,there was no statistical difference in the AOFAS-AHS score between the two groups(P>0.05).After three months of treatment,the AOFAS-AHS score in the observation group was higher than that in the control group,indicating statistical significance(P<0.05).There was an interaction between time and group(P<0.05).Conclusion Tuina plus physical agents can improve the symptoms of lateral collateral ligament injury of ankle in gymnasts.This combined treatment is superior to physical agents alone in relieving pain and improving joint functions.Therefore,Tuina plus physical agents can be used as a treatment for lateral collateral ligament injury of ankle in gymnasts.
基金This study was supported by the orthopedics special research project(Shang Antong)of Sichuan Medical Association(Grant numbers:2020SAT11)the Science and Technology Planning Project of Leshan(Grant numbers:20SZD049).
文摘Purpose:To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese,and/or with demand for highly intensive sports,and/or with poor-quality ligament remnants.Methods:A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament(ATFL)reconstruction with tensional remnant repair technique from January 2019 to August 2021.General data,including demographics,surgical time,and postoperative adverse events,were recorded.The American Orthopaedic Foot and Ankle Society score(AOFAS),foot and ankle ability measure(FAAM),visual analog scale(VAS),and anterior talar translation were measured preoperatively and at 6 weeks,3 months,and 2 years postoperatively.Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL.Data were analyzed using SPSS 19.0.F test was used to analyze the pre-and postoperative VAS,FAAM,and AOFAS scores.The significance was set at p<0.05.Results:There were 20 males and 10 females among the patients with a mean age of(30.71±5.81)years.The average surgical time was(40.21±8.59)min.No adverse events were observed after surgery.At 2 years postoperatively,the anterior talar translation test showed grade 0 laxity in all patients.VAS score significantly decreased from preoperatively to 6 weeks,3 months,and 2 years postoperatively(p<0.001).Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks,3 months,and 2 years postoperatively was statistically significant(p<0.001).At 3 months postoperatively,most patients(23/30)could return to their pre-injured activities of daily living status.At 2 years postoperatively,all patients were able to return to their pre-injured activities of daily living status,and almost every patient(18/19)who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal.The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL.Conclusion:The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation,and allowed early return to pre-injured activities,which could be a reliable option for patients with chronic lateral ankle instability.
