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Arthroscopic all-inside anterior talo-fibular ligament repair with suture augmentation gives excellent results in case of poor ligament tissue remnant quality.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2018-08-20 , DOI: 10.1007/s00167-018-5117-x
Jordi Vega 1, 2, 3 , Erik Montesinos 4 , Francesc Malagelada 5 , Albert Baduell 2, 6 , Matteo Guelfi 7 , Miki Dalmau-Pastor 1, 3, 8
Affiliation  

PURPOSE An increasing role of arthroscopy as the definitive treatment for ankle instability has been reported, and assisted or all-arthroscopic techniques have been developed. However, treatment of chronic ankle instability with poor remnant ligament-tissue quality is still challenging. The aim of this study was to describe the technique and report the results of the arthroscopic ATFL all-inside repair with suture augmentation to treat patients with poor remnant ligament-tissue quality. METHODS Fifteen patients [9 men and 6 women, median age 30 (19-47) years] with chronic ankle instability and poor remnant ligament-tissue quality were treated by arthroscopic means after failing non-operative management. Median follow-up was 18 (12-23) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, the ligament was repaired. Then, the anchor's residual suture limbs were not cut, but were recycled and used for augmentation of the ligament repair. RESULTS Arthroscopic examination demonstrated an isolated anterior talofibular ligament (ATFL) injury with poor remnant ligament tissue in the 15 patients. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligaments repair and suture augmentation. The median AOFAS score increased from 66 (44-87) preoperatively to 100 (85-100) at the final follow-up. CONCLUSION Chronic ankle instability with poor remnant ligament-tissue quality can be successfully treated by an arthroscopic all-inside repair and suture augmentation of the ligament. The clinical relevance of the study is the description of the first arthroscopic all-inside anatomic ATFL repair with suture augmentation that offers the benefit of maintaining the native ligament while reinforcing the repair, especially in patients with poor remnant ligament-tissue quality. LEVEL OF EVIDENCE IV, retrospective case series.

中文翻译:

在韧带组织残留质量较差的情况下,使用关节镜在全口内侧前踝腓骨韧带修复术中缝合增加了出色的效果。

目的已经报道了关节镜作为脚踝不稳的权威性治疗方法的作用日益增强,并且辅助或全关节镜技术已经得到发展。然而,用较差的残余韧带组织质量治疗慢性踝关节不稳仍然具有挑战性。这项研究的目的是描述该技术,并报告通过缝合线进行关节镜ATFL全内修复术的结果,以治疗残存韧带组织质量较差的患者。方法15例慢性踝关节不稳且残余韧带组织质量较差的患者(男9例,女6例,中位年龄30(19-47)岁)在非手术治疗失败后进行了关节镜检查。中位随访时间为18(12-23)个月。通过关节镜全内镜技术,并使用缝合线和两个无结锚,韧带修复。然后,不剪掉锚的残余缝合线,但将其回收再用于韧带修复。结果关节镜检查证实了15例患者中孤立的前胫腓韧带(ATFL)损伤,残余韧带组织较差。所有患者均报告了在关节镜内全韧带修复和缝合增加后其踝关节不稳定性的主观改善。最后一次随访时,AOFAS评分中位数从术前的66(44-87)增加到100(85-100)。结论关节镜全向内修复及韧带缝合可成功治疗残存韧带组织质量差的慢性踝关节不稳。这项研究的临床意义是对首次采用关节镜的全内镜解剖式ATFL缝合加缝合术的描述,这种缝合术具有在维持天然韧带的同时加强修复的益处,特别是在残余韧带组织质量较差的患者中。证据级别IV,回顾性案例系列。
更新日期:2020-01-21
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