Clinical Study Of The Diagnose And Treatment Of Chronic Lateral Ankle Instability

Part one Clinic study of B-Ultrasonography in evaluating Anterior Talofibular Ligament(ATFL) lesion --the comparison of Bus,MRI and SurgeryObjective:To assess the manifestation and clinical value of B-ultrasonography (BUS) in diagnosis and treatment of ATFL lesion.Methods:A study was done in a consecutive series of 25 patients who were clinically diagnosed with chronic instability of ankle(ATFL lesion suspected), the patients consisted of 13 men and 12 women with the average age 21.4 years (range,15-30 years).All patients were examined by both BUS and MRI.BUS examination was done with high frequency ultrasonography machine(ATL 5000) by an ultrasound expert who has great experience in ultrasound and sports trauma.On the same day all the patients accepted MRI examination(1.5T MRI).About 3 days(0-5dyas) after the examination,surgery was done by an experienced surgeon.The results of both examinations were compared with the surgical findings which were regarded as golden standard.The corresponding procedures were determined based on the findings.Results:Of all the patients,the ATFL of the injured ankle were found with the total rupture shown as disappeared in fourteen cases,with the partial torn as obscure in ten cases,with the avulsion fracture at fibula side in one case,meanwhile the healthy ATFL of the contralateral ankle were well identified by BUS.All of BUS pathological findings in 25 cases were correspondingly confirmed by surgery.The Accuracy Rate of BUS is 100%.The MRI was performed in 25 cases at the same time.19 of 25 patients was detected correctly by MRI with the same diagnosis as BUS,but 4 cases diagnosed with the partial torn of ATFL via surgery showed ATFL disappear in MRI and 2 diagnosed with partial tear via surgery appeared normal in MRI.The Accuracy Rate of MRI is 76%.Conclusions:BUS examination is an effective method in detection of ATFL lesion, and it can provide the important evidence in making decision of surgical procedure.BUS examination is better than MRI examination in detecting ATFL. Part two Early Operation effectiveness of reconstruction of the lateral ankle ligaments with allograft tendonObjective:To evaluate the method and the operation effectiveness of the treatment of the unstable ankle by ligament reconstruction using a deep-frozen allograft tendon.Methods:September 2007 to August 2008,retrospectively study 14 patients(14 ankles) who were diagnosed Chronic Ankle Instability and accepted allograft reconstruction of the lateral ankle ligaments:males 9 and females 5,age from 18 to 51 years old(average 28.0 years old).All the patients had multiple sprains anda feeling of "giving way".Anterior Drawer Test is positive and X-ray showed none of fracture.They all accepted B-ultrasound and MRI examination preoperatively.For the case that the ATFL(with ruptured CFL) is full tear without enough residual tissue,we use the allograft tendon to reconstruct the ATFL and CFL.Postoperatively all the patients had a systematical functional rehabilitation.AOFAS and KAFS were used to evaluate the ankle function preoperatively and at the final follow-up.Results:At the final follow-up of average 12.5 months(8～19months),the ankle stability was restored in all cases,and ADT negative.No infection and immunologic rejection was found within follow-up.The mean AOFAS and KAFS scores rise from 64.79 points and 51 points to 90.14 points and 91.57 points respectively after operation.According the results of AOFAS,10 cases are excellent and 4 cases are good.Conclusion:our study indicates that the stability of the ankle joint can be improved effectively by ligament reconstruction using the allograft tendon. No infection and immunologic rejection was found in the short time after surgery.The key points are arthroscopic treatment,the precise positioning of the talus,fibula and calcaneus tunnels in operation,and systematic rehabilitation training after operation in order to achieve favorable result.