全镜下踝关节外侧副韧带修补术后重返运动的影响因素研究

Influencing factors of return to sport after all-inside arthroscopic lateral collateral ligament repair for chronic ankle instability

目的探讨慢性踝关节不稳定(CAI)患者经全镜下踝关节外侧副韧带修补术后重返运动的情况及其影响因素。方法回顾性分析2017年1月至2019年8月于复旦大学附属华山医院运动医学科接受全镜下外侧副韧带修补术治疗的CAI患者。评估并比较术前术后Tegner评分、Karlsson评分,同时采用多元Cox回归模型探究术后重返期望运动的影响因素。结果共81例患者纳入本次研究,其中男44例,女37例,年龄(32.7±9.9)岁。患者Karlsson评分[M(Q1,Q3)]从术前55.0(40.0,65.0)分提升至术后的90.0(85.0,95.0)分(P<0.01),Tegner评分从术前3.0(1.0,4.0)分提升至术后的5.0(4.0,6.0)分(P<0.01)。患者术后重返期望运动项目者60例,中位重返运动时间为9.0个月。多因素Cox回归分析显示,高龄(HR=0.95,95%CI:0.92~0.99,P<0.01)、低受伤前Tegner评分(HR=1.43,95%CI:1.10~1.85,P<0.01)为阻碍术后重返运动的独立影响因素。在术后1年重返运动的截断值分别为37岁和Tegner活动水平评分4分。结论全镜下踝关节外侧韧带修补术治疗CAI可获得良好的短期疗效,并有较大可能使患者重返运动。高龄、低伤前活动水平为阻碍术后重返运动的独立影响因素。

Objective To investigate the outcomes and factors influencing postoperative return-to-sport of patients with chronic ankle instability(CAI)underwent all-inside arthroscopic lateral collateral ligament repair.Methods Patients with CAI treated at Huashan Hospital of Fudan University from January 2017 to August 2019 were retrospectively recruited.Preoperative and postoperative Tegner and Karlsson scores were evaluated and compared,and a multivariate Cox regression model was applied to explore factors influencing postoperative return to desired sports postoperatively.Results A total of 81 patients with CAI treated by all-inside arthroscopic lateral collateral ligament repair were assessed,including 44 males and 37 females with a mean age of(32.7±9.9)years.Karlsson scores(M(Q1,Q3))increased from 55.0(40.0,65.0)preoperatively to 90.0(85.0,95.0)postoperatively(P<0.01),while Tegner scores increased from 3.0(1.0,4.0)preoperatively to 5.0(4.0,6.0)postoperatively(P<0.01).Sixty patients returned to their desired sports with a median return-to-sport time of 9.0 months.Multivariate Cox regression analysis showed that higher age(HR=0.95,95%CI:0.92-0.99,P<0.01)and lower preinjury activity levels(HR=1.43,95%CI:1.10-1.85,P<0.01)were independent factors affecting postoperative return-to-sport.The one-year postoperative return-to-sport cutoff scores were 37 years old and a Tegner score of 4,respectively.Conclusions The all-inside arthroscopic lateral collateral ligament repair procedure can achieve good short-term outcomes for patients with CAI,permitting a high incidence of postoperative return-to-sport.Higher age and lower pre-injury activity levels are independent factors hindering postoperative return-to-sport.