Biomechanical Study And Clinical Application Of The Reconstruction Of The Anterior Talofibular Ligament And Calcaneofibular Ligament Under Total Ankle Arthroscopy

Objective To explore the biomechanical reliability of the all arthroscopic remnant-reserving reconstruction of ATFL and CFL of the ankle on cadaver specimens,and to provide theoretical basis for the selection of clinical treatment.Methods Eighteen fresh-frozen cadaveric ankles,including ten males and eight females,with an average age of 55 years(range,30 to 69),were thawed,dissected,and utilized in this study.Specimens were excluded if they had prior ankle ligament tears or surgery,and if they had history of cancer as the cause of death.The cadavers were kept at-20? and thawed at room temperature for 24 h before experiment.Specimens were randomized to one of three groups to be tested:(1)intact ATFL and CFL group,(2)arthroscopic anatomic reconstruction of ATFL and CFL group,and(3)all arthroscopic remnant-preserving reconstruction of ATFL and CFL group.Specimens were kept moist with saline to prevent tissue desiccation throughout testing.According to the materials and methods described below,arthroscopic anatomic reconstruction of ATFL and CFL and all arthroscopic remnant-preserving reconstruction of ATFL and CFL were respectively used in group 2 and group 3 for each foot and ankle specimen.The specimens were clamped to a custom jig in the biomechanical test.The ultimate load(N)was measured by a Dynamic Testing System.The construct stiffness(N/mm)was also determined from the load versus displacement curve by calculating the slope of the linear portion during the pull to failure.Results In load to failure testing,the ultimate failure loads of the arthroscopic anatomic(176.6 ± 44.7 N;P < 0.01)and all arthroscopic remnant-preserving reconstruction(183.7 ± 40.1 N;P < 0.01)were significantly lower than that of the intact(313.2 ± 42.4 N)ATFL and CFL group.Stiffness of the arthroscopic anatomic(8.4 ± 2.5;P < 0.01)and all arthroscopic remnant-preserving reconstruction(9.0 ± 2.2;P < 0.01)were significantly lower than that of the intact(15.4 ± 2.3)ATFL and CFL group.There were no significantly differences between the two reconstruction groups,but both two were substantially lower in strength and stiffness when compared with the intact native ATFL and CFL.The mechanism of failure was at the tendon bone bonding interface in calcaneus and talar tunnel for all specimens in both 2 reconstruction groups.The mechanism of failure for the intact state was predominantly at the distal attachment site(5 of 6 specimens),whereas the remaining one failed midsubstance.Conclusion The all arthroscopic remnant-preserving reconstruction of ATFL and CFL produces a reconstruction that can withstand loads to failure and stiffness similar to the arthroscopic anatomic reconstruction.However,both 2 reconstruction groups are much weaker than the intact,uninjured ATFL and CFL.Objective To investigate the clinical value and reliability of all arthroscopic remnant-reserving reconstruction of ATFL and CFL.Methods From December 2016 to December 2017,20 patients were enrolled in the clinical trail of all arthroscopic remnant-reserving reconstruction of ATFL and CFL,including 8 males and 12 females,with the age of 24 to 61 years(mean,40 years).All the 20 patients were followed up for 12-18 months(14 months on average).Follow-up assessment included postoperative complications,visual analogue score(VAS),American orthopedic foot and ankle society(AOFAS)score,Kofoed ankle function score,Tegner movement function score,Anterior Talar Translation(ATT)and ankle magnetic resonance imaging(MRI).Results All patients,incisions obtained healing by first intention after operation.There was no neurovascular injury and talus necrosis.The preoperative VAS score,AOFAS score,Kofoed ankle function score and Tegner movement function score of patients were 6.9 ± 0.9,52.0±4.1,39.7±6.2,2.3 ± 0.9,respectively.The 12 months follow-up VAS score,AOFAS score,Kofoed ankle function score and Tegner movement function score of patients were 1.9 ± 0.7,79.7 ± 4.3,83.3 ± 6.3,6.6 ± 0.8,respectively.The preoperative and 12 months follow-up ATT of patients were(7.8 ±2.0)mm and(2.9±0.9)mm respectively.The preoperative and 12 months follow-up VAS score,AOFAS score,Kofoed ankle function score,Tegner movement function score and ATT showed statistically significant difference(P<0.05).Ankle MRI showed that ATFL and CFL were well reconstructed in the anatomical position.Conclusion All arthroscopic remnant-reserving reconstruction of ATFL and CFL exhibits positive effect,less invasive,thus promoting the recovery of ankle function and has good short-term clinical effect.