Ayak bileği anterolateral yumuşak doku sıkışmasının artroskopik tedavisi (Ayak bileği mekanik instabilitesinin eşlik ettiği ve etmediği olguların karşılaştırılması)
Küçük Resim Yok
Tarih
2004
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: inversiyon tipi ayak bileği burkulması sonrasında gelişen, mekanik instabilitenin eşlik ettiği veya etmediği, anterolateral yumuşak doku sıkışması (ALYDS)'nın artroskopik yöntemle tedavi sonuçlarınının belirlenmesi. Hastalar ve Yöntem: Ayak bileğinde ALYDS tanısı alan sekizi erkek, onbiri kadın toplam 19 hastanın 19 ayak bileği çalışma grubunu oluşturdu. Tüm hastalarda bir veya birkaç kez geçirilmiş inversiyon tipi burkulma öyküsü ve ayak bileği anterolateral kısmında kronik ağrı şikayeti vardı. Yapılan fizik bakıda eklemde mekanik instabilite saptanan 9 hasta 1. grubu, ayak bileği stabil olarak bulunan 10 hasta 2. grubu oluşturdu. Her iki gruptaki olgulara da ALYDS’nın artroskopik debridmanı ve sıkışmaya neden oluyorsaıanteroinferior tibiofibular ligamanın distal fasikülünün rezeksiyonu uygulandı. Grup 1’de ek olarak, 6 hastaya anatomik anterior talofibular bağ onarımı, 3 hastaya ise Chrisman-Snook yöntemiyle bağ rekonstrüksiyonu gerçekleştirildi. Hastalar Amerikan Ortopedik Ayak-Ayak Bileği Derneği (AOFAS) skoru ve eski aktivite düzeyine geri dönüş süresi ile değerlendirildi. Bulgular: Olguların ortalama yaşı 28 yıl (16-50 yıl) olup, operasyon sonrası ortalama 50 ay (10-96 ay) süre ile izlenmiştir. Artroskopik debridman ve bağ onarımı uygulanan grup 1’deki olguların operasyon öncesi ortalama skoru 67 puandan (65-73), son kontrolde 88’e (76-95) yükseldi. 7 hastada mükemmel-iyi sonuç, 2 hastada orta sonuç elde edildi. Grup 1’de 6 hasta ortalama 15 hafta sonra eski aktivite düzeyini yakalayabildi. Grup 2’deki hastalaron operasyon öncesi skoru 63 puandan (39-73), son kontrolde 93’e (87-100) yükseldi. Bu gruptaki 10 hastanın tümünde deımükemmel-iyi sonuçlar elde edildi. Bu hastalardan 8’i ortalama 7 hafta sonra eski aktivite düzeyini yakaladı. İki grup arasında AOFAS skoru karşılaştırıldığında istatistiksel anlamlı fark saptanmadı (p>0.05). Eski aktivite düzeyine geri dönüş süreleri karşılaştırıldığında ise grup 2’de bu süre belirgin olarak daha kısa bulundu (p<0.05). Tartışma: Ayak bileği anterolateral yumuşak doku sıkışması, ek stabilite kazandırıcı yöntemlerin uygulanması koşulu ile eklemde mekanik instabilite varlığında bile artroskopik olarak başarılı bir şekilde tedavi edilebilir. Ancak, ayak bileği instabilitesinin eşlik ettiği hastalarda eski aktivite düzeyine ulaşma belirgin olarak daha geç sürede olmaktadır.
Objective: To evaluate the outcome of the arthroscopic treatment of the anterolateral soft tissue impingement (ALSTI) of the ankle in patients with or without ankle instability. Patients and Method: We treated 19 patients who had ALSTI of their 19 ankles by arthroscopic debridement. All had a history of single or multiple inversion injuries, followed by chronic pain over the anterolateral aspect of the ankle. There were 8 male and 11 female patients. The patients were classified into two groups according to the instability findings in physical examination. There were 9 patients who had ALSTI associated with ankle instability (Group 1) and 10 patients who had only ALSTI without ankle instability (Group 2). Arthroscopic debridement was performed of the impingement of anterolateral soft-tissue in all. And if present, an abnormally thickened distal fascicle of the anteroinferior tibiofibular ligament that was in contact with talus during dorsiflexion was also excised. Additionally, in group 1, an anatomic repair of the anterolateral talofibular ligament was done in 6 patients and reconstruction of the lateral ligament complex by Chrisman-Snook technique in the other 3 patients. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The period for returning to previous level of activitiy was also recorded. Results: The average age of the patients was 28 years (range, 16-50) and the average follow-up was 50 months (range, 10-96). The average preoperative AOFAS score of 67 points (65 to 73) improved to 88 points (76 to 95) in Group 1. Seven ankles were rated as excellent or good and 2 others as fair. Six patients returned to their previous level of physical activity at an average of 15 weeks. In Group 2, the average preoperative AOFAS score of 63 points (39 to 73) improved to 93 points (87 to 100) at the last follow-up. All of the ankles were rated excellent or good. Eight patients returned to previous activities at an average of 7 weeks. No difference was found between two groups in terms of postoperative AOFAS score (p>0.05). However, the period for returning to the previous activity level was significantly shorter in group 2 than in group 1 (p<0.05). Discussion: With additional ligament repair or reconstruction, the anterolateral soft-tissue impingement of the ankle can be successfully treated by ankle arthroscopy even in cases with ankle instability. However, the period for returning to the previous activity level was significantly longer in patients with associated ankle instability.
Objective: To evaluate the outcome of the arthroscopic treatment of the anterolateral soft tissue impingement (ALSTI) of the ankle in patients with or without ankle instability. Patients and Method: We treated 19 patients who had ALSTI of their 19 ankles by arthroscopic debridement. All had a history of single or multiple inversion injuries, followed by chronic pain over the anterolateral aspect of the ankle. There were 8 male and 11 female patients. The patients were classified into two groups according to the instability findings in physical examination. There were 9 patients who had ALSTI associated with ankle instability (Group 1) and 10 patients who had only ALSTI without ankle instability (Group 2). Arthroscopic debridement was performed of the impingement of anterolateral soft-tissue in all. And if present, an abnormally thickened distal fascicle of the anteroinferior tibiofibular ligament that was in contact with talus during dorsiflexion was also excised. Additionally, in group 1, an anatomic repair of the anterolateral talofibular ligament was done in 6 patients and reconstruction of the lateral ligament complex by Chrisman-Snook technique in the other 3 patients. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The period for returning to previous level of activitiy was also recorded. Results: The average age of the patients was 28 years (range, 16-50) and the average follow-up was 50 months (range, 10-96). The average preoperative AOFAS score of 67 points (65 to 73) improved to 88 points (76 to 95) in Group 1. Seven ankles were rated as excellent or good and 2 others as fair. Six patients returned to their previous level of physical activity at an average of 15 weeks. In Group 2, the average preoperative AOFAS score of 63 points (39 to 73) improved to 93 points (87 to 100) at the last follow-up. All of the ankles were rated excellent or good. Eight patients returned to previous activities at an average of 7 weeks. No difference was found between two groups in terms of postoperative AOFAS score (p>0.05). However, the period for returning to the previous activity level was significantly shorter in group 2 than in group 1 (p<0.05). Discussion: With additional ligament repair or reconstruction, the anterolateral soft-tissue impingement of the ankle can be successfully treated by ankle arthroscopy even in cases with ankle instability. However, the period for returning to the previous activity level was significantly longer in patients with associated ankle instability.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Artroplasti Artroskopik Cerrahi (Yeni Adı: Eklem Hastalıkları ve Cerrahisi)
WoS Q Değeri
Scopus Q Değeri
Cilt
15
Sayı
4
