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Stepwise decision making for CFL repair in addition to arthroscopic ATFL repair yields good clinical outcomes in chronic lateral ankle instability regardless of the remnant quality
Journal of Orthopaedic Science ( IF 1.7 ) Pub Date : 2022-07-06 , DOI: 10.1016/j.jos.2022.06.010
Tomoyuki Nakasa 1 , Yasunari Ikuta 2 , Junichi Sumii 2 , Akinori Nekomoto 2 , Shingo Kawabata 2 , Nobuo Adachi 2
Affiliation  

Background

Although arthroscopic anterior talofibular ligament (ATFL) repair for chronic lateral ankle instability (CLAI) has been widely performed, there are several issues such as the efficacy of the isolated ATFL repair for the ATFL and calcaneofibular ligament (CFL) injury and the influence of the poor remnant on the clinical outcomes to be discussed. This study aimed to evaluate clinical outcomes of the arthroscopic ATFL repair with the stepwise decision regarding the requirement of CFL repair and the influence of remnant qualities on clinical outcomes.

Methods

Forty-four ankles underwent arthroscopic surgery to repair the lateral ankle ligament for CLAI. After arthroscopic ATFL repair, CFL repair was performed if instability remained. Clinical outcomes including the Karlsson-Peterson (KP) scores, Japanese Society for Surgery of the Foot (JSSF) scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed at the final follow-up. ATFL remnants were classified into excellent, moderate, and poor according to the arthroscopic findings, and the clinical outcomes of each remnant group were compared.

Results

Twenty-five ankles were required for CFL repair after ATFL repair. K–P score was significantly improved from 66.1 ± 5.3 to 94.8 ± 6.5 points (p < 0.01). JSSF scale was significantly improved from 70.5 ± 4.5 to 95.9 ± 6.0 points (p < 0.01). The SAFE-Q was also significantly improved on all subscales. There were no significant differences in clinical outcomes among excellent, moderate, and poor remnants.

Conclusions

Stepwise decision for CFL repair in addition to arthroscopic ATFL repair gave satisfactory clinical outcomes in CLAI regardless of the remnant quality.



中文翻译:

无论残余质量如何,除了关节镜 ATFL 修复之外,CFL 修复的逐步决策在慢性踝关节外侧不稳定中都能产生良好的临床效果

背景

尽管关节镜下距腓前韧带(ATFL)修复术治疗慢性踝关节外侧不稳定(CLAI)已得到广泛应用,但仍存在一些问题,例如单独的距腓前韧带(ATFL)修复术对ATFL和跟腓韧带(CFL)损伤的疗效以及对距腓韧带(CFL)损伤的影响等。临床结果的不良残留有待讨论。本研究旨在评估关节镜下 ATFL 修复的临床结果,逐步决定 CFL 修复的要求以及残余质量对临床结果的影响。

方法

44 名踝关节接受了关节镜手术,修复 CLAI 的踝关节外侧韧带。关节镜下 ATFL 修复后,如果仍不稳定,则进行 CFL 修复。最终随访时评估了临床结果,包括卡尔森-彼得森 (KP) 评分、日本足部外科协会 (JSSF) 量表和自我管理足部评估问卷 (SAFE-Q)。根据关节镜检查结果将 ATFL 残迹分为优、中、差,并比较各残迹组的临床结果。

结果

ATFL 修复后需要 25 个脚踝进行 CFL 修复。K-P 评分从 66.1 ± 5.3 分显着提高至 94.8 ± 6.5 分 (p < 0.01)。JSSF 量表从 70.5 ± 4.5 分显着提高至 95.9 ± 6.0 分 (p < 0.01)。SAFE-Q 在所有分量表上也都有显着改善。优良、中等和不良残余物的临床结果没有显着差异。

结论

无论残余质量如何,除了关节镜 ATFL 修复之外,逐步决定进行 CFL 修复在 CLAI 中都取得了令人满意的临床结果。

更新日期:2022-07-06
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