دانلود رایگان مقاله روش بروستروم آرتروسکوپی تعدیل شده با تونل استخوان

Abstract

The open anatomic repair of the anterior talofibular and calcaneofibular ligaments (modified Brostrom procedure) is widely accepted as the standard surgical stabilization procedure for lateral ankle instability that does not respond to conservative measures. Arthroscopic Brostrom procedures with a suture anchor have been reported to achieve both anatomic repair of the lateral ankle ligaments and management of the associated intra-articular lesions. However, the complication rates are higher than open Brostom procedures. Many of these complications are associated with the use of a suture anchor. We report a modified arthroscopic Brostrom procedure in which the anterolateral ankle capsule is anchored to the lateral malleolus through small bone tunnels instead of suture anchors.

Discussion

The arthroscopic Brostrom procedure is a viable alternative of the open procedure (Table 1). The cadaveric study showed that there is no statistical difference in strength or stiffness of a traditional open repair as compared with an arthroscopic anatomic repair of the lateral ligaments of the ankle.18 It is indicated in symptomatic lateral ankle instability that does not respond to conservative therapy. The arthroscopic approach allows the surgeon to address both the lateral ligament instability and associated intra-articular pathologies without extensive dissection. Moreover, it has the advantages of minimally invasive surgery, for example, small incisions, less soft tissue trauma, and better cosmetic result. Most of the reported arthroscopic techniques use a suture anchor to reattach the anterior talofibular ligament to the lateral malleolus. Potential complications of using a suture anchor in the lateral malleolus include dislodgement of the implant, iatrogenic fracture of the lateral malleolus, and malpositioning of the implant causing impingement of the syndesmosis or the peroneal tendons.19 The transosseous tunnel fixation technique instead of a suture anchor technique is used in this technique. This has been a popular choice for open lateral ligament reconstruction for ankle instability. The strength of pullout is at least comparable with a suture anchor.20