Concurrent arthroscopic osteochondral lesion treatment and lateral ankle ligament repair has no substantial effect on the outcome of chronic lateral ankle instability
Concurrent arthroscopic osteochondral lesion treatment and lateral ankle ligament repair has no substantial effect on the outcome of chronic lateral ankle instability
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同步进行关节镜骨软骨损伤治疗和踝关节外侧韧带修复对慢性踝关节外侧不稳的结局没有实质性影响
DOI：
10.1007/s00167-017-4774-5
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发表时间：
2018-10-01
影响因子：
3.8
通讯作者：
Hu, Yue-lin
中科院分区：
文献类型：
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作者：
Jiang, Dong;Ao, Yin-fang;Hu, Yue-lin
目的探讨关节镜下骨软骨病变（OCL）治疗和踝关节外侧韧带修复对慢性踝关节外侧不稳预后的影响。假设关节镜下OCL治疗可能会影响康复计划，从而对慢性外侧踝关节不稳定（CLAI）的预后产生一些负面影响。方法2010 ~ 2012年对70例CLAI患者行踝关节镜及解剖性踝外侧韧带缝合锚钉修复术。34例患者（A组），男性20例，女性14例，中位年龄为30岁（14 - 54岁），接受关节镜下磨损、刮除、钻孔或微骨折治疗ocl。从术后2周开始，每天取下夹板进行关节运动练习，术后8周至12周允许完全负重。其余36例未合并OCL的患者（B组）作为对照随访。评估和比较术前和术后视觉模拟量表（VAS）评分、美国骨科足踝学会（AOFAS）评分、Tegner评分、扭伤复发、踝关节稳定性和活动范围（ROM）。结果A组和B组的中位随访时间分别为46.5（38 ~ 55）个月和44.5（38 ~ 56）个月。两组患者术后VAS评分、AOFAS评分、Tegner评分中位数较术前均有改善，90%以上患者预后良好至优。两组患者的主观评分和满意度无显著差异。A组9例（26.5%）复发扭伤，B组5例（13.9%）复发扭伤。A组ROM限制发生率明显高于B组（23.5% vs 5.6%，P= 0.043）。结论关节镜治疗OCL联合踝关节外侧韧带修复对CLAI患者整体中期预后无明显负面影响，但存在活动受限的潜在风险。证据水平ii。
PurposeThe purpose of the study was to evaluate the effect of concurrent arthroscopic osteochondral lesion (OCL) treatment and lateral ankle ligament repair on the outcome of chronic lateral ankle instability. It was hypothesized that the arthroscopic OCL treatment might have some negative effect on the outcome of chronic lateral ankle instability (CLAI) by compromising the rehabilitation program.MethodsAnkle arthroscopy and anatomic lateral ankle ligament repair with suture anchors were performed for 70 patients with CLAI between 2010 and 2012. Thirty-four patients (group A), 20 males and 14 females with a median age of 30(14–54) years, received arthroscopic abrasion, curettage, drilling, or microfracture for OCLs. The splint was removed daily for joint motion exercises beginning at post-operative 2 weeks and full weight bearing was allowed between post-operative week 8 and 12. The other 36 patients (group B) with no combined OCL were followed up as controls. Pre-operative and post-operative visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores, sprain recurrence, ankle stability, and range of motion (ROM) were evaluated and compared.ResultsThe median follow-up was 46.5 (38–55) months and 44.5 (38–56) months for group A and group B, respectively. The median post-operative VAS score, AOFAS score, and Tegner score were improved from the pre-operative level for both groups with good-to-excellent results for more than 90% patients. No significant difference was found between the two groups for the subjective scores and satisfaction rate (n.s.). Recurrent sprain was found among nine patients(26.5%) of the group A and five patients (13.9%) of the group B (n.s.). The incidence of the ROM restriction of group A was significantly higher than in group B (23.5 vs 5.6%,P= 0.043).ConclusionsThe concurrent arthroscopic treatment of OCL with lateral ankle ligament repair demonstrated no substantial negative effect on the overall mid-term outcome of the patients with CLAI except for a potential risk of ROM restriction.Level of evidenceIII.