Surgical Considerations in the Treatment of Ankle Instability.

摘要: OBJECTIVE: To review the surgical indications, techniques, biomechanical testing, and clinical results reported for most common techniques used to treat ankle instability. DATA SOURCES: We searched MEDLINE from 1960-2001 using terms instability, functional mechanical ligament surgery, Brostrom, Chrisman-Snook, Evans. SYNTHESIS: Although 80% 85% of acute sprains are successfully treated with a ankle-rehabilitation program, remaining 15% 20% have recurrent instability reinjury, necessitating intervention. The fundamentals approach lateral based on anatomy ligaments, anterior talofibular ligament, calcaneofibular ligament. Ankle-instability surgery has been broadly divided into an anatomic repair consisting imbrication ligamentous complex ankle-ligament reconstruction. An reconstruction weaves harvested tendon graft, commonly peroneus brevis, augment ligaments ankle. Goals reestablish stability function without compromising motion complications. Anatomic Gould modification 95% success rate, risk associated nerve injuries is low. This provides increased by reinforcing local host tissue, preserving subtalar talocrural motion, eliminating comorbidity tendon-graft harvest, offering quicker recovery. One concern in resultant strength repair, although literature does not support this concern. Ankle-reconstruction procedures that sacrifice tendons thought provide stronger construct, hence, more stability. loss range prolonging recovery decreasing sport performance. Adjacent injury CONCLUSIONS/RECOMMENDATIONS: Based literature, we believe modified Brostrom lateral-ligament should be considered first choice persistent refractory protocol. Ankle augmentation reserved patients generalized laxity or long-standing insufficiency as salvage procedure patient failed repair.