Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: A multicenter study
Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: A multicenter study
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DOI：
10.1177/107110070102200510
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发表时间：
2001-05-01
影响因子：
2.7
通讯作者：
Karlsson, J
中科院分区：
文献类型：
--
作者：
Krips, R;van Dijk, CN;Karlsson, J
一项回顾性多中心研究评估了解剖重建和肌腱固定术治疗慢性前外侧踝关节不稳定后的长期临床结果。第一组 (AR) 包括 25 名接受解剖重建的患者（手术时平均年龄 22 岁 +/- 5.7 岁），第二组 (TE) 包括 29 名接受肌腱固定术的患者（平均手术年龄 23 岁 +/- 6.6 岁）。两组的平均随访期均为 12.3 年（AR +/- 2.5 年，TE 2.7 年）。体检时，与 AR 组 (n=7) 相比，TE 组 (n=18) 前抽屉征阳性的患者明显更多 (p=0.02)。标准 X 光片上可见的踝关节内侧退行性改变在 TE 组 (n=7) 中比 AR 组 (n=1) 更常见 (p=0.03)。在放射照相应力检查中，AR 组的平均距骨倾斜为 4.7 度，而 TE 组为 6.9 度（p=0.02），距骨前平移为 AR 组的 2.9 毫米，而 TE 组为 4.3 毫米（p=0.04），均显着高于 TE 组。根据 Good 等人开发的评级系统。 (1975)，与 AR 组 (n=15) 相比，TE 组 (n=8) 具有优异结果的患者明显较少 (p=0.03)，与 AR 组 (n=2) 相比，TE 组 (n=9) 具有一般或较差结果 (p=0.04) 的患者较多。我们的结论是肌腱固定术不能恢复踝关节外侧韧带的正常解剖结构。与解剖重建相比，肌腱固定术在功能和机械稳定性以及长期随访的总体满意度方面导致较差的结果。
The long-term clinical outcome after anatomical reconstruction and tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicentre study.The first group (AR) consisted of 25 patients (mean age at operation 22 yrs +/- 5.7) who underwent anatomical reconstruction and the second group (TE) of 29 patients (mean age 23 yrs +/- 6.6) who underwent tenodesis. For both groups, the mean follow-up period was 12.3 yrs (AR +/- 2.5 yrs, TE 2.7 yrs). At physical examination, there were significantly more patients in the TE group (n=18) with a positive anterior drawer sign as compared with the AR group (n=7) (p=0.02). Medially located degenerative changes in the ankle joint as seen on standard radiographs were seen more often in the TE group (n=7) than in the AR group (n=1) (p=0.03). The mean talar tilt, 4.7degrees in the AR group vs 6.9degrees in the TE group, (p=0.02) and anterior talar translation, 2.9 mm in the AR group vs 4.3 mm in the TE group, (p=0.04) were significantly higher in the TE group at radiographic stress examination. According to the rating system developed by Good et al. (1975), significantly fewer patients in the TE group (n=8) had an excellent result as compared with the AR group (n=15) (p=0.03) and more patients in the TE group (n=9) had a fair or poor result (p=0.04) as compared with the AR group (n=2). We conclude that a tenodesis procedure does not restore the normal anatomy of the lateral ankle ligaments. When compared with anatomical reconstruction, a tenodesis leads to inferior results in terms of functional and mechanical stability, as well as overall satisfaction at long-term follow-up.