Ryan B Rigby, Sarah J Ingwer, Nathan Ptak, Justin Fleming, Oliver Hauck, Anthony N Khoury
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引用次数: 0
Abstract
Background: Diagnosis and treatment of medial deltoid ligament instability is inconsistent.
Purpose: This biomechanical study evaluated arthroscopic drive-through sign as a viable and reproducible diagnostic method to determine chronic deltoid instability and determined the restorative potential of combined medial and lateral ligament repair on ankle stability.
Study design: Controlled laboratory study METHODS: The proximal tibia (n=5) was mounted in 20° plantar flexion. Anterior translation was simulated by loading specimens with 2kg/3kg/4kg. Arthroscopic drive-through sign and anterior translation distance were evaluated at the following ligament release and repair phases: intact, lateral instability, dual-sided instability, dual-sided repair, and lateral repair alone. Arthroscopic drive-through was attempted with 2.0-5.0mm diameter probes before each phase. A positive arthroscopic drive-through sign was defined as passage into the medial gutter.
Results: Positive arthroscopic drive-through sign for intact specimens were observed with 2.0mm (4/5) and 2.5mm (1/5) probes. In the dual-sided instability model, probe sizes ranged from 3.5mm to 4.5mm. Dual-sided repair restored the medial gutter distance to intact. The lateral repair alone did not restore to intact. Anterior translation in dual-sided instability was significantly greater than intact (14.3±1.9mm[12.6-16.0] vs. 7.4±1.5mm[6.1-8.7], P<0.001). Dual-sided repair and lateral repair alone restored intact anterior translation (4.8mm±0.8mm[4.1-5.5], P=0.637; 7.0±1.1mm[6.0-8.0], P=0.958).
Conclusion: The arthroscopic drive-through sign seems to be a reliable method to detect medial deltoid instability. Combined medial and lateral ligament repair effectively restores anterior translation to intact levels. Medial deltoid repair contributed to 23.2% of the total anterior translation reduction from the dual-sided instability phase to dual-sided repair phase.
背景：三角韧带内侧不稳的诊断和治疗不一致。目的：本生物力学研究评估关节镜下驾车穿过标志作为一种可行且可重复的诊断方法来确定慢性三角肌不稳定，并确定内侧和外侧韧带联合修复对踝关节稳定性的恢复潜力。研究设计：对照实验室研究方法：胫骨近端（n=5）以20°足底屈曲固定。通过2kg/3kg/4kg的载荷模拟标本的前平移。在以下韧带释放和修复阶段（完整、外侧不稳定、双侧不稳定、双侧修复和单独外侧修复）评估关节镜下的穿过标志和前路平移距离。在每个阶段之前，尝试使用2.0-5.0mm直径的关节镜穿透探针。关节镜下通过标志为进入内侧沟的通道。结果：使用2.0mm（4/5）和2.5mm（1/5）探针观察到完整标本的关节镜驾车通过阳性标志。在双面不稳定模型中，探针尺寸在3.5mm到4.5mm之间。双侧修复后内侧沟距恢复完整。单靠外侧修复不能恢复到完整。双侧不稳定患者的前平移明显大于完整患者（14.3±1.9mm[12.6-16.0] vs. 7.4±1.5mm[6.1-8.7]）。结论：关节镜下穿过标志似乎是检测内侧三角肌不稳定的可靠方法。联合内侧和外侧韧带修复有效地恢复前平移到完整的水平。从双侧不稳定期到双侧修复期，内侧三角肌修复贡献了23.2%的总前平移复位。
期刊介绍：
The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.
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