Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation
Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation
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DOI：
10.1177/2473011421s00970
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发表时间：
2022-11-21
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关节镜；踝关节；运动虽然关节镜下踝关节外侧韧带修复(ALLR)的微创意味着可以预期早日恢复运动，但许多报告描述了术后石膏固定和避免一段时间的负重。加速康复(AR)，将制动时间保持在最短时间，并积极进行早期负重训练，可能有助于早日恢复运动。本研究的目的是探讨ALLR合并AR的治疗结果，包括术后最短的踝关节固定时间和积极的早期负重。共有22名患者(男性11名，女性11名，平均年龄38.7岁)的23个踝关节因慢性踝关节外侧不稳定而接受了ALLR手术。术后处理包括避免负重，直到术后第3天(POD)，之后允许完全负重行走。目标是在手术后8周重返竞技体育。术前、术后主要症状、踝关节活动度(ROM值)、应力X线片、电容式应变传感器测量的前移位(AT)、日本足外科学会(JSSF)踝-后足量表和自填式足部评估问卷(SAFE-Q)进行评估。术后所有患者的不稳定和疼痛均得到缓解或改善。术后关节活动度无明显变化。应力X线片显示距骨平均倾斜角(12°~5.6°)、平均前抽屉距离(8.2 mm~4.4 mm)、平均AT(10.5 mm~4.6 mm)均有明显改善。JSSF量表明显改善(从68.8分提高到96.8分)，SAFE-Q在所有分量表上都有显著改善。术后8周，75%的患者完全恢复运动能力。从术后第3天开始，在没有踝关节固定的情况下进行主动负重训练，踝关节稳定性的客观评估和临床评分均有显著改善，高达75%的患者能够在8周内完全恢复运动。
Arthroscopy; Ankle; Sports Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, many reports have described postoperative cast immobilization and the avoidance of weight-bearing for a certain period of time. Accelerated rehabilitation (AR), in which the period of immobilization is kept to a minimum and early weight-bearing exercises are actively introduced, may be helpful for an early return to sport. The purpose of this study was to investigate the therapeutic outcomes of ALLR with AR including the minimum duration of postoperative ankle immobilization and proactive early weight-bearing. A total of 23 ankles of 22 patients (11 men, 11 women; mean age 38.7 years) who underwent ALLR for chronic lateral ankle instability were investigated. Postoperative management included the avoidance of weight-bearing until postoperative day (POD) 3, after which full weight-bearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. Preoperative and postoperative major symptoms, ankle range of motion (ROM), stress X-ray assessment, anterior translation (AT) measured with a capacitance-type strain sensor, the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in ROM. There were significant improvements in the mean talar tilt angle (from 12° to 5.6°), in the mean anterior drawer distance (from 8.2 mm to 4.4 mm) on stress X-rays, and in the mean AT (from 10.5 mm to 4.6 mm). The JSSF scale improved significantly (from 68.8 to 96.8), and the SAFE-Q improved significantly on all subscales. Complete return to sport was achieved by 75% of the patients at 8 weeks after surgery. When AR with proactive weight-bearing exercises was implemented from POD 3 without ankle immobilization after ALLR, there were significant improvements in both objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.