Anatomical reconstruction with allogeneic tendon graft for chronic ankle instability

doi:10.3969/j.issn.2095-4344.2014.27.022

Abstract

Abstract:

BACKGROUND: There is little evidence on the use of allogeneic tendon graft in the reconstruction of ankle joint.
OBJECTIVE: To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved allogeneic tendon graft in patients with chronic ankle instability.
METHODS: Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved allogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity.
RESULTS AND CONCLUSION: All the 26 patients were followed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from (48.4±3.7) points preoperatively to (88.2±3.8) postoperatively, while that in the group of anterior talofibular ligament was improved from (50.0±6.4) points preoperatively to (89.5±3.4) points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved allogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: ankle joint, lateral ligament, ankle, allogeneic

CLC Number:

R318

Sha Yong, Tang Hui, Ding Jing, Xu Yong-qing, Li Fu-bing, Ruan Mo, Li Chun-xiao. Anatomical reconstruction with allogeneic tendon graft for chronic ankle instability[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(27): 4401-4405.

Figures/Tables 1

2.1 参与者数量分析纳入患者26例，治疗后均获随访9-24个月，平均15个月，全部进入结果分析。 2.2 前抽屉试验和内翻应力试验结果所有患者均未出现复发性踝关节外侧不稳，查体前抽屉试验和内翻应力试验阴性。 2.3 美国足踝外科协定(AOFAS)评分结果同时修复跟腓韧带和距腓前韧带组：治疗前(48.4±3.7)分，治疗后(88.2±3.8)分，治疗后较治疗前平均提高39.8分，差异有显著性意义(t=27.375，P < 0.001)。单独修复距腓前韧带组：治疗前(50.0±6.43)分，治疗后(89.5±3.38)分，治疗后较治疗前平均提高39.5分，差异有显著性意义(t=19.855，P < 0.001)。 2.4 患者患侧与健侧踝关节背伸、跖屈活动度、后足活动度比较 25例单侧踝关节外侧韧带损伤的患者踝关节背伸、跖屈活动度、后足活动度与健侧比较，背伸(14.8±2.3)°，未伤侧(15.4±2.1)°；跖屈(44.5±2.6)°，未伤侧(45.7±3.2)°；后足活动度(19.4±2.1)°，未伤侧(19.5±3.0)°；二者均无显著差异。25例患者完全恢复到受伤以前的活动度和活动量，无任何特殊不适，1例患者踝关节内翻活动轻度受限，剧烈活动后外踝周围出现短暂疼痛和肿胀，经踝部保护支持带治疗后完全好转。 2.5 Good评级结果同种异体肌腱解剖重建后患者19例为优，6例为良，1例为中，疗效优良率达96%。完全恢复至伤前活动度和活动量的时间为10-14周，平均11.4周，参加体育运动时间为6-9个月，平均7.4个月。 2.6 不良反应 3例出现轻度排异反应，体温均在37.5 ℃以下，切口周围轻微红肿疼痛，有少许分泌物，细菌培养阴性，考虑为免疫排斥反应所致，经过每日换药2次， 3-5 d后伤口干燥，所有患者切口均一期愈合。1例因瘢痕增生，出现足背皮神经卡压症状，经手术松解后症状缓解。 2.7 典型病例介绍患者男性，32岁，因踝关节反复内翻扭伤1年余就诊，术中见跟腓韧带断裂，残端回缩，距腓前韧带明显松弛，予同种异体距骨前肌腱移植重建。治疗后石膏固定6周，改用踝关节保护支具，非负重功能锻炼1个月，然后逐渐负重，3个月正常行走，治疗后半年恢复运动(图2)。"

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