Abstract：
Surgical treatment of chronic ankle instability (CAI) typically includes ligament repair or reconstruction. Using preoperative ultrasonography or magnetic resonance imaging (MRI) to choose an appropriate arthroscopic procedure is still difficult. The aim of this study was to evaluate the correlation of imaging studies with arthroscopic findings and support the arthroscopic surgical decision-making process.
One hundred twelve patients with chronic anterior talofibular ligament (ATFL) injuries were treated using the arthroscopic surgical decision-making process from November 2018 to August 2020. Preoperative imaging assessments using dynamic ultrasonography, MRI, and combined methods were applied to categorize the ATFL remnants into three quality grades (\"good,\" \"fair,\" and \"poor\"). Arthroscopic findings were classified into 6 major types (7 subtypes) and used to select an appropriate surgical procedure. Correlations between imaging studies, arthroscopic findings, and surgical methods were evaluated. Diagnostic parameters, clinical outcomes, and complications were also assessed.
There was a significant interobserver agreement in the evaluation of dynamic ultrasonography (0.954, P < 0.001), MRI (0.958, P < 0.001), and arthroscopy diagnosis (0.978, P < 0.001). There was a significant correlation between the modified imaging classifications, arthroscopic diagnostic types, and surgical procedures. The mean follow-up period was 33.58 ± 8.85 months. Significant improvements were documented in postoperative ankle functions when assessed with Karlson-Peterson scores and Cumberland Ankle Instability Tool scores. The risk of complications is also very low.
The modified classifications and surgical decision-making process based on dynamic ultrasonography, MRI, and arthroscopic findings, as proposed in this study, might help in selecting an appropriate arthroscopic surgical procedure for chronic ATFL injuries.
One hundred twelve patients with chronic anterior talofibular ligament (ATFL) injuries were treated using the arthroscopic surgical decision-making process from November 2018 to August 2020. Preoperative imaging assessments using dynamic ultrasonography, MRI, and combined methods were applied to categorize the ATFL remnants into three quality grades (\"good,\" \"fair,\" and \"poor\"). Arthroscopic findings were classified into 6 major types (7 subtypes) and used to select an appropriate surgical procedure. Correlations between imaging studies, arthroscopic findings, and surgical methods were evaluated. Diagnostic parameters, clinical outcomes, and complications were also assessed.
There was a significant interobserver agreement in the evaluation of dynamic ultrasonography (0.954, P < 0.001), MRI (0.958, P < 0.001), and arthroscopy diagnosis (0.978, P < 0.001). There was a significant correlation between the modified imaging classifications, arthroscopic diagnostic types, and surgical procedures. The mean follow-up period was 33.58 ± 8.85 months. Significant improvements were documented in postoperative ankle functions when assessed with Karlson-Peterson scores and Cumberland Ankle Instability Tool scores. The risk of complications is also very low.
The modified classifications and surgical decision-making process based on dynamic ultrasonography, MRI, and arthroscopic findings, as proposed in this study, might help in selecting an appropriate arthroscopic surgical procedure for chronic ATFL injuries.
摘要：
目的：慢性踝关节不稳（CAI）的手术治疗通常包括韧带修复或重建。使用术前超声检查或磁共振成像（MRI）来选择合适的关节镜手术仍然很困难。这项研究的目的是评估影像学研究与关节镜检查结果的相关性，并支持关节镜手术决策过程。
方法：2018年11月至2020年8月，采用关节镜手术决策过程治疗112例慢性距腓前韧带（ATFL）损伤患者。使用动态超声检查进行术前影像学评估，MRI,并采用组合方法将ATFL残留物分为三个质量等级(“好，\"\"公平，\"和\"poor\")。关节镜检查结果分为6种主要类型（7种亚型），用于选择合适的手术方法。影像学研究之间的相关性，关节镜检查结果，并对手术方法进行了评价。诊断参数,临床结果，并对并发症进行了评估.
结果：在动态超声评估中，观察者之间存在显着一致性（0.954，P<0.001），MRI(0.958,P<0.001),关节镜诊断(0.978,P<0.001)。修改后的影像学分类之间存在显着相关性，关节镜诊断类型，和外科手术。平均随访时间为33.58±8.85个月。当使用Karlson-Peterson评分和Cumberland踝关节不稳定工具评分进行评估时，术后踝关节功能显着改善。并发症的风险也很低。
结论：基于动态超声的改良分类和手术决策过程，MRI,和关节镜检查结果，正如这项研究中提出的，可能有助于为慢性ATFL损伤选择合适的关节镜手术方法。
方法：2018年11月至2020年8月，采用关节镜手术决策过程治疗112例慢性距腓前韧带（ATFL）损伤患者。使用动态超声检查进行术前影像学评估，MRI,并采用组合方法将ATFL残留物分为三个质量等级(“好，\"\"公平，\"和\"poor\")。关节镜检查结果分为6种主要类型（7种亚型），用于选择合适的手术方法。影像学研究之间的相关性，关节镜检查结果，并对手术方法进行了评价。诊断参数,临床结果，并对并发症进行了评估.
结果：在动态超声评估中，观察者之间存在显着一致性（0.954，P<0.001），MRI(0.958,P<0.001),关节镜诊断(0.978,P<0.001)。修改后的影像学分类之间存在显着相关性，关节镜诊断类型，和外科手术。平均随访时间为33.58±8.85个月。当使用Karlson-Peterson评分和Cumberland踝关节不稳定工具评分进行评估时，术后踝关节功能显着改善。并发症的风险也很低。
结论：基于动态超声的改良分类和手术决策过程，MRI,和关节镜检查结果，正如这项研究中提出的，可能有助于为慢性ATFL损伤选择合适的关节镜手术方法。
