| Background:The ankle joint is the major weight-bearing joint of our bodies while its articular surface is smaller than that of the hip or knee joint but bears a larger portion of body weight. It serves as the fulcrum when falling on the ground or in sudden start and stop. Above all, the ankle joint becomes the most vulnerable joint in human body. The stability of the ankle is maintained mainly by the medial and lateral ligaments and the collateral ligament injury is the most common injuries in sports. For example, there are more than2million injuries of lateral ankle ligaments annually in the United States and the incidence of this disease is as much as20%or even more in athletes. It occurs when the ankle is turned unexpectedly in any direction which goes beyond the tolerance of the ligaments with the most common being due to hyper-inversion, which damages the lateral ankle ligaments. The lateral stabilizing ligaments of the ankle consist of the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL) and calcaneofibular ligament (CFL). The ATFL is the most frequently injured lateral ankle ligament.Although the pathogenesis and diagnosis of the lateral ankle ligament injury have been widely studied, even today, there is still no uniform diagnostic plan or disease grading method. Diagnosis of the disease mainly relies on history taking, physical examination and X-ray film or Magnetic Resonance. Some other examinations have also been reported, arthrography for example. Many people tend to use the ankle MR to assist diagnosis. However, MR imaging is too expensive for most people to afford as a routine screening method. At the same time, there is also considerable diverges about the treatment. A multi-center study in Germany of early years showed that the conservative treatment was significantly superior to surgical treatment in ankle collateral ligament injury and the treatment effectiveness showed low correlation with the degree of injury. At present, most scholars believe that conservative treatment is not so reliable especially for patients with severe ligament injury which could easily lead to persistent pain, instability, and osteoarthritis or even habitual sprain in severe cases. That could leave great bad impact in the work and life of the people involved especially athletes. There are a variety of surgical procedures, some surgeons take the direct repair method and some others take ligament reconstruction surgery. However, there is no conclusion for the best surgical approach for this disease. After reading the previous literature and summarizing both the previous diagnosis in this disease, and the treatment process, we take a retrospective study of the clinical data of153cases suffered from ankle collateral ligament injury from Second Hospital of Shandong University, to seek of the best method of diagnosis and treatment options and to reduce the incidence of the long-term pain and joint instability derived by misdiagnosis or inappropriate treatment of lateral collateral ligament injury as far as possible.Purpose:To summarize the diagnosis, treatment and follow-up data of153cases with ankle lateral ligament injury and to further investigate the best diagnosis and treatment methods of ankle lateral ligament injury to guide clinical work and to avoid misdiagnosis and malpractice as far as possible.Methods:We made a retrospective analysis of diagnosis, treatment and the follow-up results of153patients who were diagnosed as the ankle lateral ligament injury. The data was admitted by Orthopedic Department of the Second Hospital of Shandong University from January2006to October2011. Depending on the detailed history, physical examination and the stress position X-ray film of the injured side ankle, we made a quickly and accurate diagnosis of the ankle lateral ligament injury. The injuries were classified into three grades. Then a discussion is made about the advantages and disadvantages of different diagnostic methods. Conservative treatment or fixed prosthesis repair surgery through the use of line anchors were performed to the153patients. All of the153patients were followed up and they received a questionnaire1year after the injury. The recovery evaluation criterion is according to the Good ankle lateral ligament injury criteria. The therapeutic effect between conservative treatment and surgical treatment were statistically analyzed in patients under different levels:partial and completely lateral ligament rupture.Results:1. Details of mechanism in injury of153patients were asked. Careful physical examination including the varus stress test and anterior drawer test of the injured ankle, the conventional X-ray and varus position of X-ray film were obtained to draw an accurate diagnosis.2. In the121patients with partial rupture of the ankle lateral ligament,70patients were taken to the conservative treatment among which92.9%patients got an excellent result according to the Good ankle lateral ligament injury criteria at follow-up. At the same time,94.1%of the51patients who took operative treatment got the same result as the conservative patients.No significant difference was found in treatment effect of conservative treatment and surgical treatment (P=1.000)(Table1); Completely rupture of talofibular ligaments was found in32patients;13cases were treated conservatively and the excellent rate was46.1%;19patients were taken with a fixed prosthesis repair with anchors and line and the excellent rate was78.9%; There was significant difference (P=0.003)(Table2) between the two groups of treatment and surgical treatment was significantly better than conservative treatment.Conclusions:1. Anterior talofibular ligament injury is the most common one in lateral collateral ligament injuries and severe cases may be associated with ligament injury of calcaneofibular ligament, the posterior talofibular ligament injury is rare.2. Detail history is necessary, as well as careful physical examination including the varus stress test and anterior drawer test of the injured ankle, the conventional X-ray and varus position of X-ray film, to diagnose the lateral collateral ligament injury simply, quickly, economically and accurately. The MR imaging examination is no superior to X ray film in diagnosis and is expensive and cannot serve as a screen test for lateral collateral ligament injury.3. There are a variety of surgical treatments for ankle lateral collateral ligament injury, the fixed prosthesis repair with anchors and line can not only restore the physiological length of the ligament, but restore the function of ligaments and ensures the stability, it also has the advantage of easy to operate producing less damage and having exact effect compared with other surgeries.4. Choosing of treatment of ankle lateral collateral ligament injury should be based on the actual situation of patients, patients with partial rupture of the anterior talofibular ligament patients are recommended conservative treatment, as for completely rupture of anterior talofibular ligament fracture or associated with rupture of calcaneofibular ligament are recommend surgery, the procedure of fixed prosthesis repair with anchors and line can produce satisfactory effect. |
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