踝外侧慢性不稳镜下两种锚钉修复距腓前韧带比较△（开放获取）

Comparison of two anchor techniques in arthroscopic repair of anterior talofibular ligament for chronic lateral ankle insta⁃ bility

摘要:

[目的]比较两种锚钉技术关节镜下距腓前韧带（anterior talofibular ligament, ATFL）修复中的临床效果。[方法]回顾性分析 2018 年 1 月—2021 年 1 月本院关节镜下锚钉修复 ATFL 的 88 例患者的临床资料。根据术前医患沟通结果，49 例患者采用无结锚钉修复技术 （无结组），另外 39 例患者采打结锚钉修复技术 （打结组）。比较两组围手术期、随访及影像资料。 [结果]两组手术时间、失血量、切口长度、下地行走时间及住院时间的差异均无统计学意义（P＞0.05），但是，无结组出现异物反应的比率显著低于打结组 （0% vs 33.3%, P＜0.001）。所有患者均获得 24 个月以上的随访，两组患者恢复完全负重时间的差异无统计学意义 （P＞0.05）。与术前相比，末次随访两组踝背伸-跖屈 ROM、Karlsson-Peterson 评分、AOFAS 评分较术前均显著增加（P＜0.05），而踝内翻-外翻 ROM 和 VAS 评分显著减少（P＜0.05），前抽屉试验显著改善（P＜0.05）。相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，末次随访时两组的距骨内翻应力位距骨倾斜角 （ta- lar tilt, TT） 和前抽屉应力距骨前移位 （anterior displacement, AD） 值均显著减少 （P＜0.05）。相应时间点，两组间 TT 及 AD 值的差异均无统计学意义（P＞0.05）。[结论]两种锚钉关节镜下 ATFL 修复技术治疗慢性踝关节外侧韧带损伤，均能够恢复稳定性，取得良好的临床效果。相比之下，无结锚钉的早期异物反应更小。

Abstract:

[Objective] To compare the clinical outcomes of two anchor techniques in arthroscopic repair of the anterior talofibular liga- ment (ATFL) for chronic lateral ankle instability (CLAI). [Methods] A retrospective study was performed on 88 patients who underwent ar- throscopic repair of ATFL with anchors for CIAI in our hospital from January 2018 to January 2021. According to the doctor-patient com- munication preoperatively, 49 patients received repair with the knotless anchor, while the other 39 patients were with the knotted anchor. The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although there were no significant differences in operation time, intraoperative blood loss, incision length, walking time and hospital stay between the two groups (P＞0.05), the knotless group got significantly lower incidence of foreign body reaction than the knoted group (0% vs 33.3%, P＜0.001). All patients were followed for more than 24 months, and there was no statistically significant difference in the time to regain full weight bearing between the two groups (P＞0.05). Compared with those preoperatively, the ankle dorsal extension-plantar flexion range of motion (ROM), Karlson-Peterson score and AOFAS score significantly increased (P＜0.05), while the varus-valgus ROM and VAS scores significantly reduced (P＜0.05), and the anterior drawer test significantly improved in both groups at the latest follow-up (P＜0.05). However, there were no statistically signifi- cant differences in the above indexes between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the talar tilt (TT) under inversion stress and anterior displacement (AD) under anterior drawer stress significantly reduced in both groups at the last followup compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both kinds of anchor used in arthroscopic repair of ATFL for the CLAI do restore stability and achieve good clinical consequences. In contrast, the knotless anchor has less the early foreign body reaction than the knotted counterpart.