慢性外侧踝关节不稳手术治疗后不稳复发的风险因素：系统性综述

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-03-22 DOI:10.1002/jeo2.70214

Ronny Lopes, Choon Chiet Hong, James Calder, Gino M. M. J. Kerkhoffs

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引用次数: 0

摘要

目的识别、回顾和总结慢性外侧踝关节不稳（CLAI）外侧踝关节韧带手术治疗失败的风险因素。方法根据 PRISMA 指南进行系统回顾。2023 年 7 月，对 PubMed、Medline、CINAHL、Cochrane 和 Embase 数据库进行了文献检索。如果文章是用英语发表的定量研究，并报告了不稳定复发的风险因素，则被纳入其中。结果通过检索策略共找到 496 篇文章，其中 9 篇被纳入。所有文章均为低质量的队列研究（3 级或 4 级证据）。这九项研究共有 762 名参与者，符合纳入标准。根据不稳定性复发的定义，有 89 名患者（11%）治疗失败，失败率从 5.7% 到 28.5% 不等。六种风险因素分为三类：患者人口统计学特征（全身关节松弛[GJL]、高水平体育活动和女性性别）、影像学特征（后足外翻排列）和手术结果（残余外侧韧带质量差、术中巩膜增宽）。结论 GJL、高水平体育活动、女性性别、后足屈曲排列、韧带质量差和术中巩膜增宽等风险因素的存在应指导手术策略，以降低 CLAI 外侧踝关节韧带修复治疗失败的风险。证据等级 IV 级，系统综述。

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Risk factors for the recurrence of instability after operative treatment of chronic lateral ankle instability: A systematic review

Purpose

To identify, review and summarize risk factors for failure of lateral ankle ligament operative treatment for chronic lateral ankle instability (CLAI).

Methods

A Systematic review according to PRISMA guidelines was performed. In July 2023, a bibliographic search of the PubMed, Medline, CINAHL, Cochrane, and Embase databases was performed. Articles were included if they were quantitative studies published in English and reported risk factors for recurrence of instability.

Results

A total of 496 articles were identified using the search strategy, and nine articles were included. All were low-quality cohort studies (level 3 or 4 evidence). These nine studies comprising 762 participants met the criteria for inclusion. Eighty-nine patients (11%) had treatment failure as defined by recurrence of instability, with rates ranging from 5.7% to 28.5%. Six risk factors were divided into three categories: patient demographics (generalized joint laxity [GJL], high-level sports activities and female sex), imaging features (varus hindfoot alignment), and surgical findings (poor quality of the remnant lateral ligaments, intraoperative syndesmosis widening).

Conclusion

The presence of risk factors such as GJL, high-level sports activities, female sex, varus hindfoot alignment, poor ligament quality, and intraoperative syndesmosis widening should guide surgical strategy to reduce the risk of treatment failure in lateral ankle ligament repair for CLAI.