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The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique.

关节镜下全内侧踝关节外侧副韧带修复是一种安全、可重复的技术。

  • 影响因子:3.28
  • DOI:10.1007/s00167-019-05427-0
  • 作者列表:"Guelfi M","Vega J","Malagelada F","Dalmau-Pastor M
  • 发表时间:2020-01-01
Abstract

PURPOSE:Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair. METHODS:Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve. RESULTS:Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen. CONCLUSIONS:The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.

摘要

目的: 在关节镜下全内侧外侧副韧带修复治疗慢性踝关节不稳的过程中,踝关节周围的神经血管结构有损伤的风险。本研究旨在评估关节镜下全内韧带修复不同专业水平的外科医生对解剖结构的损伤风险和技术的可重复性。 方法: 采用 12 例新鲜冷冻踝关节标本进行研究。两名对该技术有不同经验的足踝外科医生分别对 6 个标本进行手术。按照最初描述的标准化程序进行修复。然后,一位经验丰富的解剖学家解剖了所有标本,以评估韧带修复的结果、解剖结构的任何损伤以及关节镜门户和腓浅神经 (SPN) 之间的距离和腓肠神经。 结果: 解剖显示神经无损伤。与前外侧门静脉和SPN的平均距离为 4.8 (范围 0.0-10.4) mm。副前外侧门静脉至SPN和腓肠神经的平均距离分别为 14.2 (范围 7.1-32.9) mm和 28.1 (范围 2.8-39.6) mm。2 个手术组之间的差异对于任何测量 (mm) 均无统计学意义。在所有标本中,距腓前韧带的两个束都重新附着在其原始腓骨足迹上。任何标本均未穿透跟骨腓韧带。 结论: 关节镜下全内侧外侧副韧带修复是一种安全、可重复的方法。这项研究的临床相关性是,这项技术提供了一个安全的解剖复位距腓前韧带,无论技术经验水平如何,周围解剖结构损伤的风险最小。

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