만성 외측 발목 불안정
Chronic Lateral Ankle Instability
0
조회
0
다운로드
8
인용
0
참고문헌
키워드
초록
Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients’ history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified Broström operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.
Abstract
Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients’ history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified Broström operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.
참고문헌 (30)
- van Rijn RM, "What is the clinical course of acute ankle sprains? A systematic literature review", Am J Med, 121, pp.324~331 (2008)[DOI]
- DiGiovanni CW, "Current concepts: lateral ankle instability", Foot Ankle Int, 27, pp.854~866 (2006)[DOI]
- Freeman MA, "Instability of the foot after injuries to the lateral ligament of the ankle", J Bone Joint Surg Br, 47, pp.669~677 (1965)
- Hiller CE, "Chronic ankle instability: evolution of the model", J Athl Train, 46, pp.133~141 (2011)[DOI]
- Gribble PA, "Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium", Br J Sports Med, 48, pp.1014~1018 (2014)[DOI]
- Caprio A, "Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability", Foot Ankle Clin, 11, pp.597~605 (2006)[DOI]
- Louwerens JW, "Stress radiography of the talocrural and subtalar joints", Foot Ankle Int, 16, pp.148~155 (1995)[DOI]
- Cho JH, "Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy", Knee Surg Sports Traumatol Arthrosc, 24, pp.1022~1028 (2016)[DOI]
- Maffulli N, "Management of acute and chronic ankle instability", J Am Acad Orthop Surg, 16, pp.608~615 (2008)[DOI]
- Ajis A, "Conservative management of chronic ankle instability", Foot Ankle Clin, 11, pp.531~537 (2006)[DOI]
- Donovan L, "A new paradigm for rehabilitation of patients with chronic ankle instability", Phys Sportsmed, 40, pp.41~51 (2012)
- Karlsson J, "Lateral instability of the ankle joint (1). Non-surgical treatment is the first choice--20 per cent may need ligament surgery", Lakartidningen, 88, pp.1399~1402 (1991)
- Karlsson J, "Surgical treatment of chronic lateral instability of the ankle joint. A new procedure", Am J Sports Med, 17, pp.268~273 (1989)[DOI]
- Karlsson J, "Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint", Am J Sports Med, 25, pp.48~53 (1997)[DOI]
- Cho BK, "Comparison between suture anchor and transosseous suture for the modified-Brostrom procedure", Foot Ankle Int, 33, pp.462~468 (2012)[DOI]
- Lee KT, "Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study", Knee Surg Sports Traumatol Arthrosc, 16, pp.781~786 (2008)[DOI]
- Jeong BO, "Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Brostrom procedures", Foot Ankle Int, 35, pp.1137~1142 (2014)[DOI]
- Corte-Real NM, "Arthroscopic repair of chronic lateral ankle instability", Foot Ankle Int, 30, pp.213~217 (2009)[DOI]
- Guelfi M, "Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review", Foot Ankle Surg, 24, pp.11~18 (2018)[DOI]
- Kerkhoffs GM, "There is no simple lateral ankle sprain", Knee Surg Sports Traumatol Arthrosc, 24, pp.941~943 (2016)[DOI]
- Shakked RJ, "Operative treatment of lateral ligament instability", Curr Rev Musculoskelet Med, 10, pp.113~121 (2017)[DOI]
- Schenck RC Jr, "Lateral ankle instability and revision surgery alternatives in the athlete", Foot Ankle Clin, 14, pp.205~214 (2009)[DOI]
- Matheny LM, "Activity level and function after lateral ankle ligament repair versus reconstruction", Am J Sports Med, 44, pp.1301~1308 (2016)[DOI]
- Sha Y, "A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments", Int Orthop, 40, pp.59~64 (2016)[DOI]
- Vuurberg G, "Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques", Knee Surg Sports Traumatol Arthrosc (2017)
- 박준성, "족관절 외측 인대 봉합 후 실패의 위험 인자", 대한족부족관절학회지, 20(2), pp.62~66 (2016), 대한족부족관절학회[DOI]
- Viens NA, "Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Brostrom repair techniques with the intact anterior talofibular ligament", Am J Sports Med, 42, pp.405~411 (2014)[DOI]
- Cho BK, "Outcomes of the modified Brostrom procedure augmented with suture-tape for ankle instability in patients with generalized ligamentous laxity", Foot Ankle Int, 38, pp.405~411 (2017)[DOI]
- Knop C, "Treatment of recurrence of fibular ligament rupture. Results of a prospective randomized study", Unfallchirurg, 102, pp.23~28 (1999)[DOI]
- Pearce CJ, "Rehabilitation after anatomical ankle ligament repair or reconstruction", Knee Surg Sports Traumatol Arthrosc, 24, pp.1130~1139 (2016)[DOI]