Treatment Of Anterolateral Instability Of Chronic Ankle Joint By Reconstruction Of Anterior Talofibular Ligament Injury With Different Surgical Methods Clinical Study

Objective: To compare the clinical effects of modified Brostr?m,Karlsson and arthroscopic Brostr?m on chronic lateral ankle instability.Methods: From July 2015 to July 2018,45 cases of mechanical ankle instability were treated,including 29 males.16 females,aged 24-45 years(averaged,29.3+5.9)years.Among them,31 are engaged in competitive sports,14 are non-athletes,28 are left ankle and 17 are right ankle.All patients were randomly divided into modified Brostr?m group,modified Karlsson group and arthroscopic Brostr?m group.VAS score,AOFAS score,Tegner score,anterior displacement and tilt of talus,and postoperative complications were evaluated before and 1 year after operation in the three groups.Results:(1)There was no significant difference in sex,age,side,injury time and preoperative AOFAS score among the three groups(p > 0.05).(2)The AOAS score,Mazur score and VAS score of the modified Brostr?m group,Karlsson group and arthroscopic Brostr?m group before and 1 year after operation were significantly higher than those before operation(p < 0.01).(3)The AOFAS score of arthroscopic Brostr?m group before operation was lower than that of modified Brostr?m group and modified Karlsson group,but there was no significant difference between the two groups after treatment(p > 0.05).(4)There was no significant difference in Tegner and VAS score among the three groups after operation.(5)The anterior distance of talus and the inclination angle of talus in the three groups after operation were significantly reduced compared with those before operation(P < 0.01).(6)In the modified Brostr?m group,4 case had necrosis at the edge of the knife and 6 cases had ankle swelling.In the modified modified Karlsson group,3 cases had local swelling and pain at the edge of the knife,7 cases had ankle swelling and 2 cases had local pain at the incision.In arthroscopic Brostr?m group,1 case suffered from sural nerve cutaneous branch injury and local residual numbness,which recovered 6 months after operation.1 case presented with swelling of ankle joint and no wound healing or infection.(p <0.01)Conclusion: All three methods can restore the stability of the ankle joint to a certain extent,and the postoperative AOFAS score,talus advancing and tilting have basically returned to normal exercise levels.However,in terms of local incision complications,aesthetic appearance,and the incidence of limb swelling after surgery,the patients in the arthroscopic Brostr?m group were significantly lower than those in the other two groups.