PURPOSE The etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome. METHODS Eighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation. RESULTS From the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury. CONCLUSION Professional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury. LEVEL OF EVIDENCE IV.

中文翻译：

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慢性外侧踝不稳定性增加了三角骨综合征运动员进行手术的可能性。

目的职业运动员三角骨综合征的病因和发病率变化很大。缺乏足够的数据来确定为什么有些运动员发展为外科手术而另一些仍无症状。我们假设外侧韧带踝关节损伤会增加那些患有三角骨综合症运动员的手术可能性。方法鉴定了80名具有三角骨综合症临床和放射学症状的专业运动员，以通过磁共振成像（MRI）来确定外侧韧带踝复合体（急性和慢性）受伤的发生率。该队列又分为2组；外科手术（n = 40）和非手术组（n = 40）。确定手术分割是否（1）临床足底屈曲试验阳性，（2）超声引导下诊断性注射阳性，（3）保守康复6周后未见改善。结果手术队列中，有37例（94.1％）的患者在MRI上发生了慢性侧踝韧带损伤，而3例（5.9％）的患者出现了急性侧踝韧带损伤。二进制逻辑线性模型表明，与急性侧韧带损伤相比，慢性侧韧带损伤使三角骨综合征手术的可能性增加了十倍。结论患有慢性外侧韧带踝关节损伤的职业运动员与急性外侧韧带踝关节损伤的运动员相比，发生三角骨综合征手术的风险大约高十倍。证据级别IV。结果手术队列中，有37例（94.1％）的患者在MRI上发生了慢性侧踝韧带损伤，而3例（5.9％）的患者出现了急性侧踝韧带损伤。二进制逻辑线性模型表明，与急性侧韧带损伤相比，慢性侧韧带损伤使三角骨综合征手术的可能性增加了十倍。结论患有慢性外侧韧带踝关节损伤的职业运动员与急性外侧韧带踝关节损伤的运动员相比，发生三角骨综合征手术的风险大约高十倍。证据级别IV。结果手术队列中，有37例（94.1％）的患者在MRI上发生了慢性侧踝韧带损伤，而3例（5.9％）的患者出现了急性侧踝韧带损伤。二进制逻辑线性模型表明，与急性侧韧带损伤相比，慢性侧韧带损伤使三角骨综合征手术的可能性增加了十倍。结论患有慢性外侧韧带踝关节损伤的职业运动员与急性外侧韧带踝关节损伤的运动员相比，发生三角骨综合征手术的风险大约高十倍。证据级别IV。二进制逻辑线性模型表明，与急性侧韧带损伤相比，慢性侧韧带损伤使三角骨综合征手术的可能性增加了十倍。结论患有慢性外侧韧带踝关节损伤的专业运动员与急性外侧韧带踝关节损伤的运动员相比，发生三角骨综合征手术的风险大约高十倍。证据级别IV。二进制逻辑线性模型表明，与急性侧韧带损伤相比，慢性侧韧带损伤使三角骨综合征手术的可能性增加了十倍。结论患有慢性外侧韧带踝关节损伤的职业运动员与急性外侧韧带踝关节损伤的运动员相比，发生三角骨综合征手术的风险大约高十倍。证据级别IV。