Abstract：
OBJECTIVE: To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft.
METHODS: Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed.
RESULTS: Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed.
CONCLUSIONS: Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients\' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory.
METHODS: IV.
METHODS: Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed.
RESULTS: Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed.
CONCLUSIONS: Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients\' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory.
METHODS: IV.
摘要：
目的：评估高风险人群中使用自体肌腱移植重建踝关节外侧韧带治疗慢性踝关节外侧不稳定（CLAI）后的临床结果以及恢复运动（RTS）和恢复工作（RTW）率。并比较接受自体股薄肌腱移植（GT）和自体腓骨短肌腱自由分裂（PBT）移植的患者之间的这些结果参数。
方法：28名连续患者，他们被诊断出患有CLAI，存在≥1个危险因素(韧带过度松弛，天然韧带和/或高需求运动员的物质不足)，2011年1月至2018年12月接受自体肌腱移植踝关节韧带重建的患者纳入本回顾性研究.63.7±28.0个月（24-112），23名平均年龄29.7±10.9岁的患者可进行随访。卡尔松得分,脚和脚踝结果评分（FAOS），在最少24个月的随访时间内收集Tegner活动量表和疼痛视觉模拟量表(VAS).通过问卷调查对RTS和RTW进行评估。对用于踝关节韧带重建的移植物（GT与PBT）进行了亚组分析。
结果：患者报告Karlsson评分为82.1±17.5（37-100），FAOS得分为87.8±8.4（73-99），Tegner活动量表中位数为5.0（IQR4-6），静息时疼痛的VAS为0.5±0.9（0-4），最终随访时活动时疼痛的VAS为2.0±2.1（0-7）。术后,在8.3±6.2个月后，96％的患者恢复了运动。所有患者（100％）在3.5±5.7（0-24）个月恢复工作，与术前相比，87%的人报告工作能力相等或提高。术后,与PBT分裂患者的术前相比，每周运动小时数显着减少（n=12；13.0±12.9至5.6±6.4h，p=0.038）自体移植物，而不是GT自体移植物的患者（n=11；13.1±8.7至12.4±7.1h，n.s.)。没有观察到其他组的差异。
结论：在接受自体肌腱移植进行CLAI的踝关节韧带重建的高风险患者中，可以获得良好的患者报告结果以及良好的RTS和RTW率。这些结果可能有助于术前管理患者对运动和工作相关结果的期望，并提供有关个人返回运动和工作轨迹的预期时间框架的切实数据。
方法：IV.
方法：28名连续患者，他们被诊断出患有CLAI，存在≥1个危险因素(韧带过度松弛，天然韧带和/或高需求运动员的物质不足)，2011年1月至2018年12月接受自体肌腱移植踝关节韧带重建的患者纳入本回顾性研究.63.7±28.0个月（24-112），23名平均年龄29.7±10.9岁的患者可进行随访。卡尔松得分,脚和脚踝结果评分（FAOS），在最少24个月的随访时间内收集Tegner活动量表和疼痛视觉模拟量表(VAS).通过问卷调查对RTS和RTW进行评估。对用于踝关节韧带重建的移植物（GT与PBT）进行了亚组分析。
结果：患者报告Karlsson评分为82.1±17.5（37-100），FAOS得分为87.8±8.4（73-99），Tegner活动量表中位数为5.0（IQR4-6），静息时疼痛的VAS为0.5±0.9（0-4），最终随访时活动时疼痛的VAS为2.0±2.1（0-7）。术后,在8.3±6.2个月后，96％的患者恢复了运动。所有患者（100％）在3.5±5.7（0-24）个月恢复工作，与术前相比，87%的人报告工作能力相等或提高。术后,与PBT分裂患者的术前相比，每周运动小时数显着减少（n=12；13.0±12.9至5.6±6.4h，p=0.038）自体移植物，而不是GT自体移植物的患者（n=11；13.1±8.7至12.4±7.1h，n.s.)。没有观察到其他组的差异。
结论：在接受自体肌腱移植进行CLAI的踝关节韧带重建的高风险患者中，可以获得良好的患者报告结果以及良好的RTS和RTW率。这些结果可能有助于术前管理患者对运动和工作相关结果的期望，并提供有关个人返回运动和工作轨迹的预期时间框架的切实数据。
方法：IV.
