Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity-patellar tendon autograft for chronic lateral ankle instability
Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity-patellar tendon autograft for chronic lateral ankle instability
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DOI：
10.1177/2309499018780874
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发表时间：
2018-06-11
影响因子：
1.6
通讯作者：
Xu, Daqi
中科院分区：
文献类型：
--
作者：
Chen, Can;Lu, Hongbin;Xu, Daqi
引言：当局部韧带组织严重衰减时，距腓前韧带（ATFL）的解剖修复具有挑战性。自体胫骨结节-髌腱（TT-PT）解剖重建ATFL是一种可行的选择，可以避免复杂的腱-骨愈合，恢复踝关节的稳定性。材料与方法：从2009年到2015年，31例慢性外侧踝关节不稳定（CLAI）患者（31个踝关节）仅在ATFL上有严重损伤，采用TT-PT对ATFL进行解剖重建。采用美国足踝矫形协会踝后足评分（AHS）、视觉模拟疼痛评分（VAS）、Karlsson-Peterson评分、Tegner活动度及综合活动度的客观检查评价手术前后的临床疗效。在术前和术后踝关节应力视图中，通过X线片评估距骨倾斜角和前抽屉。结果：31个踝关节中，17个踝关节为单束ATFL，14个踝关节为双束ATFL。平均随访42个月（24-82个月），所有患者均对手术感到满意。平均AHS从60.5 +/- 8.2显著增加至93.5 +/- 4.8。平均Karlsson-Peterson评分从术前的55.2 +/- 11.0显著增加至最终随访时的91.2 +/- 6.9。平均VAS从术前的5.9 ± 1.6显著降低至末次随访时的1.4 ± 1.0。术前平均Tegner活动水平为3.7 ± 0.9，术后为7.0 ± 0.8。应力X线片显示，术前平均距骨倾斜角为17.0 ± 3.4度，末次随访时为3.8 ± 2.1度。此外，术前平均胫距前平移为7.5 +/- 2.2 mm，末次随访时为1.8 +/- 1.1 mm。结论：使用TT-PT自体移植物进行ATFL的解剖重建允许距骨的骨-骨愈合和腓骨的肌腱-肌腱/骨膜愈合，而不需要肌腱-骨愈合，这是治疗单一ATFL功能不全引起的CLAI的替代选择。
Introduction: Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity-patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon-bone healing and restore ankle stability. Materials and methods: From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle-hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson-Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. Results: Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24-82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 +/- 8.2 to 93.5 +/- 4.8. Mean Karlsson-Peterson score significantly increased from 55.2 +/- 11.0 preoperatively to 91.2 +/- 6.9 at final follow-up. Average VAS significantly decreased from 5.9 +/- 1.6 preoperatively to 1.4 +/- 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 +/- 0.9 before operation, compared with 7.0 +/- 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 +/- 3.4 degrees before operation and 3.8 +/- 2.1 degrees at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 +/- 2.2 mm before operation and 1.8 +/- 1.1 mm at the latest follow-up. Conclusion: Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone-bone healing in talus and tendon-tendon/periosteum healing in fibula rather than requiring tendon-bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.