Tractament artroscòpic de la inestabilitat de turmell: anatomia, riscs i complicacions
- Autores: Matteo Guelfi
- Directores de la Tesis: Rosa María Mirapeix Lucas (dir. tes.), Miquel Dalmau Pastor (codir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2021
- Idioma: catalán
- Tribunal Calificador de la Tesis: Joan Carles Monllau Garcia (presid.), Antonio Viladot Voegeli (secret.), Stefan Clockaerts (voc.)
- Programa de doctorado: Programa de Doctorado en Cirugía y Ciencias Morfológicas por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Introduction During the last few years, the role of arthroscopy in treating ankle instability has rapidly evolved alongside arthroscopic stabilizing techniques. These techniques have, as a working area, the anterolateral aspect of the ankle. In this area, there are several anatomical structures which may be at risk during the creation of the portals and the passage of the sutures. Due to this, to perform any of these techniques a thorough knowledge of both superficial and arthroscopic anatomy is mandatory to reduce the rate of complications and obtain successful outcomes.
Scientific Rationale Arthroscopic stabilizing techniques of the ankle are very different from each other. All of them have their own indications, advantages and pitfalls and with no clear superiority of one technique over the other. With this Thesis safety and reproducibility of all-inside ligament repair is analyzed and the two most popular techniques, the all-inside repair and the arthroscopic Broström are compared determining which one is safer and provides better clinical results.
Hypothesis and Objectives Hypothesis: Ankle arthroscopic stabilizing techniques provide excellent clinical outcomes. Within these techniques, the all-inside ligament repair is a safe and reproducible technique for the treatment of chronic ankle instability, with minimal risk for surrounding anatomical structures. Comparing the two most popular techniques, the all-inside repair and the arthroscopic Broström, the all-inside is a fully arthroscopic procedure and avoids percutaneous passage of the suture. For this reason, it may be safer, providing better clinical outcomes and less complications.
Objectives: 1. To evaluate the risk of damage and entrapment of neurological structures during the arthroscopic all-inside lateral collateral ligament repair.
2. To investigate the reproducibility of the all-inside lateral ligament repair among surgeons with varying levels of expertise in the technique.
3. To compare clinical outcomes and complications of the two most popular techniques for arthroscopic treatment of ankle instability: the all-inside repair and the arthroscopic Broström.
Study design This compendium of publications is mainly composed of 4 articles and 2 book chapters. All the articles have been published in peer-reviewed and indexed journals.
Results The most important result of this thesis is that the arthroscopic all-inside lateral collateral ligament repair is a safe and reproducible technique and, compared to other stabilizing techniques such as arthroscopic Broström, has less potential risk of complications. In the first published study of this thesis, no cases of suture entrapment of any anatomical surrounding structures were reported during the arthroscopic all-inside lateral collateral ligament repair. The second publication of this thesis showed a significantly higher complication rate for the arthroscopic Broström compared to the all-inside repair (40% vs 5.3%; p<0.05). In addition, the arthroscopic Broström technique reported an ankle plantarflexion deficit greater than 10° present in 20% of patients (4 cases). This high rate of ROM limitation was not observed in the all-inside repair group, with only 1 case (5%) reported.
Conclusions 1. The arthroscopic all-inside lateral collateral ligament repair is a safe technique with minimal risk of damage to surrounding neurological structures.
2. The arthroscopic all-inside lateral collateral ligament repair is a reproducible technique regardless of the surgeon’s level of experience.
3. Both the arthroscopic Broström and the all-inside repair are suitable surgical options to treat chronic ankle instability providing excellent clinical outcomes. However, the arthroscopic Broström has a higher rate of complications, particularly involving neuritis of the superficial peroneal nerve and restrictions in range of motion.
