Purpose

Diagnosis and treatment of subtalar instability (STI) remains complicated and challenging. The purpose of this study was to investigate the outcome of an anatomical reconstruction of the cervical ligament in patients with suspected chronic STI.

Methods

This prospective study assessed the results of a surgical reconstruction of the cervical ligament using a gracilis tendon graft in a group of 14 patients (16 feet). Diagnosis of STI was performed using a predefined algorithm including clinical signs, MRI and peroperative evaluation. All patients had symptoms of chronic hindfoot instability despite prolonged non-surgical treatment. At final follow-up the outcome was assessed using the Karlsson score, the Foot and Ankle Outcome Score and the American Orthopaedic Foot and Ankle Society score.

Results

After an average follow up of 22.6 months (range, 15–36), all patients reported significant improvement compared to their preoperative symptoms. The mean preoperative Karlsson score improved from 36.4 ± 13.5 (median 37, range 10–55) to a mean postoperative Karlsson score was 89.6 ± 8.5 (median 90, range 72–100) (P < 0.0001). The cervical ligament reconstruction was combined with other procedures in 13 cases: calcaneofibular ligament (CFL) reconstruction (3), CFL and anterior talofibular ligament reconstruction (7), bifurcate ligament reconstruction (3).

Conclusion

Anatomical reconstruction of the cervical ligament is a valid technique to treat patients with STI. It is a safe procedure and produces good clinical results with minimal complications. This technique can be considered in more complex cases and can be combined with other procedures according to the specific location of the instability.

Level of evidence

Level III

中文翻译：

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慢性距下不稳患者颈韧带的重建

目的

距下不稳 (STI) 的诊断和治疗仍然复杂且具有挑战性。本研究的目的是调查疑似慢性 STI 患者颈韧带解剖重建的结果。

方法

这项前瞻性研究评估了一组 14 名患者（16 英尺）使用股薄肌腱移植物重建颈韧带的手术结果。STI 的诊断是使用预定义的算法进行的，包括临床体征、MRI 和围手术期评估。尽管进行了长期的非手术治疗，所有患者都有慢性后足不稳的症状。在最后的随访中，使用 Karlsson 评分、足部和踝关节结果评分以及美国足踝骨科协会评分评估结果。

结果

平均随访 22.6 个月（范围 15-36 个月）后，所有患者均报告与术前症状相比有显着改善。平均术前 Karlsson 评分从 36.4 ± 13.5（中位数 37，范围 10-55）提高到平均术后 Karlsson 评分 89.6 ± 8.5（中位数 90，范围 72-100）（P < 0.0001）。颈韧带重建联合其他手术13例：跟腓韧带（CFL）重建（3），CFL和距腓前韧带重建（7），分叉韧带重建（3）。

结论

颈韧带的解剖重建是治疗 STI 患者的有效技术。这是一个安全的程序，并产生良好的临床效果，并发症最少。这种技术可以考虑在更复杂的情况下，并可以根据不稳定的具体位置与其他程序结合使用。

证据等级

三级