Selim ŞANEL, Faik Murat ÜNSAL, Nurullah ERMİŞ, Ender UGUTMEN, Can SOLAKOĞLU

Ayak Bileği Kronik Lateral İnstabilitesinin Colville Tekniği ile Tedavisi

Amaç: Ayak bileği lateral bağlarının kronik lezyonlarında, Colville tekniğinin uygulandığı genç hastalardaki sonuçların değerlendirilmesi. Metod: 2008-2010 yılları arasında kronik ayak bileği lateral instabilitesi olan yedi erkek bir bayan hastaya ort. yaş 22; yaş dağılımı 20-35 güçlendirilmiş Colville tekniğiyle rekonstrüksiyon uygulandı. Yaralanmadan ameliyata kadar geçen süre ortalama 29 ay idi dağılımı 21-33 ay . Sekiz hastada da Trevino'nun değerlendirme kriterlerine göre tip IIIc ayak bileği lateral bağ lezyonu vardı. Olgular ortalama 42 ay süreyle dağılım 24-60 ay takip edildi. Bulgular: Tüm olgularda mükemmel sonuç elde edildi. Hiçbir hastada reküren instabilite gözlenmedi. Enfeksiyon, sural sinir lezyonu gibi komplikasyonlara rastlanmazken 1 hastada sınırlı yüzeyel cilt nekrozu saptandı. Sonuç: Colville tekniğiyle, stabilite %100'e yakın oranlarda sağlanırken, subtalar eklem hareketleri de korunmaktadır.

Anahtar Kelimeler:

ateral ayak bileği, ligament instabilitesi, Colville

Surgical Treatment of Chronic Lateral Ankle Instability with Collville's Technique

Aim: We evaluated the results of Colville's technique in young patients with chronic lateral ankle instability. Methods: Between 2008 and 2010, reconstruction of lateral ankle ligaments with Colville's augmented technique was performed in seven male and one female patients mean age 22, range 20-35 years with chronic lateral ankle instability. The interval between injury and operation ranged from 21 months to 33 months mean 29 months . According to Trevino's classification system, all patients had grade IIIc lateral ankle injuries. Mean follow- up was 42 months range 24-60 months . Results: We achieved excellent results in all patients. None of the patients developed recurrent instability. Complications such as infection, sural-nerve injury were not encountered but superficial limited skin necrosis was seen in one patient. Conclusion: By means of Colville's technique, a stability of nearly 100% can be obtained, with preservation of subtalar joint motions.

Keywords:

lateral ankle, ligament instability, Colville,

PDF

___

Karlsson J, Sward L, Andreasson GO. The effect of taping on ankle stability. Sports Med 1993; 16: 210-215.
Renstrom PA, Konradsen L. Ankle ligament inju- ries. Br. J. Sports Med. 1997; 31: 11-20.
Hamilton WG. Current concepts in the treatment of the acute and chronic lateral ankle instability. Sports Med. Arth Rev. 1994; 2: 264-266.
Ege R. Ayak bileği kırık ve çıkıkları. Ayak ve ayak bileği sorunları 1997: 741-801.
Bennet WF. Lateral ankle sprains. Orthop. Rev. 1994; 23: 381-387.
Roberts CS, De Maio M, Larkin JJ, Paine R. Ankle sprains. Orthopedics 1995; 18: 298-304.
Colville MR. Reconstruction of the lateral ankle li- gaments. J Bone Joint Surg [Am] 1994; 76: 1092- 1102.
Karsson J. Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg [Am] 1988; 70: 581-588.
Rodop O, Kıral A, Arpacıoğlu ÖM. Lateral ayak bi- leği ligamanlarının Colville tekniği ile geç dönem rekonstrüksiyonu. Acta Orthop Traumatol Turc 2000; 34: 293-299.
Ahlgren O, Larsson S. Reconstruction for lateral ligament injuries of the ankle. J Bone Joint Surg [Br] 1989;71: 300-303.
Snook GA, Chrisman OD, Wilson TC. Long-term results of the Chrisman-Snook operation for re- construction of the lateral ligaments of the ank- le. J Bone Joint Surg [Am] 1985; 67: 1-7.
Chrisman OD, Snook GA. Reconstruction of late- ral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie pro- cedure. J Bone Joint Surg [Am] 1969; 51:904-912.
Trevino SG, Davis P, Hecht PJ. Management of acute and chronic lateral ligament injuries of the ankle. Orthop Clin North Am 1994; 25: 1-16.
Yetkin H, Kanatlı U. Ayak Bileği Bağ Yaralanmala- rı. Acta Orthop Traumatol Turc 2002; 36 Suppl 1: 9-20.
Chen CY, Huang PJ, Kao KF, Chen JC, Cheng YM, Chiang HC, Lin CY. Surgical reconstruction for ch- ronic lateral instability of the ankle. Injury. 2004; 35: 809-813.
Schmidt R, Benesch S, Friemert B, Herbest A, Cla- es L, Gerngross H. Anatomical repair of lateral ligaments in patients with chronic ankle instabi- lity. Knee Surg Sports Traumatol Arthrosc. 2005; 13: 231-237.
Horstman JK, Kantor GS, Samuelson KM. Investi- gation of lateral ankle ligament reconstruction. Foot Ankle 1981; 1: 338-342.
Krips R, Brandsson S, Swensson C, van Dijk CN, Karsson J. Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle. Clinical and radiological findings after follow-up for 30 years. J Bone Joint Surg [Br] 2002 ; 84:232– 236.
Anderson ME. Reconstruction of the lateral liga- ments of the ankle using the plantaris tendon. J Bone Joint Surg [Am] 1985; 67: 930-934.
Van der Rijit AJ, Evans GA. The long –term results of Watson-Jones tenodesis. J Bone Joint Surg [Br] 1984;66: 371-375.
Keklikçi K, Şahin O, Yıldırım C, Solakoğlu C, Kıral A, Pehlivan Ö, Akmaz İ. Treatment of chronic late- ral instability of the ankle with the Colville tech- nique: A prospective analysis with minimum five years of follow up. Joint Diseases and Related Surgery; 2012;23: 35-39.