Arthroskopische Außenbandstabilisierung bei chronischer Instabilität des Sprunggelenks

Baumbach, S. F.; Braunstein, M.; Herterich, V.; Böcker, W.; Waizy, H. und Polzer, H. (2019): Arthroskopische Außenbandstabilisierung bei chronischer Instabilität des Sprunggelenks. In: Operative Orthopadie und Traumatologie, Bd. 31, Nr. 3: S. 201-210

Abstract

ObjectiveRepair of the lateral ligament complex of the ankle joint;identification and treatment of intra-articular pathologies.IndicationsSymptomatic chronic lateral ankle instability. Treatment of osteochondral lesions associated with lateral ankle instability.ContraindicationsOsteoarthritis of the ankle joint, risk factors such as peripheral occlusive disease, diabetic foot syndrome, complex regional pain syndrome.Surgical techniqueDiagnostic arthroscopy of the ankle joint utilizing anterolateral and -medial portals;identification and treatment of intra-articular pathologies;identification and preparation of the distal fibula;insertion of two suture anchors;the sutures are passed inside-out through the joint capsule, the scarred lateral ligaments, the extensor retinaculum using asuture lasso;by tying down the sutures the tissue grasped is then pulled against the distal fibula;this will stabilize the lateral ligament complex.Postoperative managementPartial weight-bearing and short leg cast for 2weeks, then 4weeks ankle brace and range of motion exercises, thereafter functional physical therapy, ankle brace only during exercises;no sports for at least 3 months.ResultsCurrently, one randomized controlled trial is available comparing open to arthroscopic lateral ankle ligament repair. Open repair was always combined with arthroscopy to treat intra-articular pathologies. In all patients, surgery led to asignificant increase of the American Orthopaedic Foot and Ankle Score (AOFAS), Karlsson Score and visual analog score (VAS), but no significant differences between the open and arthroscopic procedure after one year with similar complications (arthroscopy group: 3temporary nerve irritations and 2 patients with pain over the knot;open treated group: 2temporary nerve irritations and one abscess). Intra-articular pathologies were treated in 68% of the arthroscopically treated patients and 70% of the patients treated by open surgery. One out of two retrospective comparative studies reported asignificantly shorter operation time and time to return to daily activity and significantly lower VAS three days postoperatively for arthroscopically treated patients, while the other parameters assessed were comparable.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0934-6694
• Sprache: Deutsch