Prise en charge des patients atteints de métastases cérébrales de mélanome

Abstract

The purpose of this study was to describe the positioning of bone tunnels of arthroscopic anatomical reconstruction of lateral ankle ligaments (AAR-LAL) and identify radiological measurements associated with short-term clinical outcome one year after surgery.A total of 61 patients were included in this IRB-approved retrospective study. There were 52 men and 9 women, with a mean age of 36.3 ± 10.8 (SD) years. AAR-LAL was performed to treat chronic instability secondary to strain sequelae after failure of conservative treatment. Good short-term clinical outcome was defined by Karlsson-score ≥ 80 (n = 40) one year after surgery. Sixteen radiological measurements were studied to characterize the positionings of fibular, talar and calcaneal tunnels (FT, TT and CT, respectively). Feasibility and inter-observer agreement were calculated for each measurement. Receiver operating characteristic curves were used to identify optimal thresholds for measurements associated with outcome at univariate analysis. A binary logistic regression was used to identify independent predictors.Two measurements were associated with good outcome: distance from the proximal FT entrance to the distal end of the fibula on anteroposterior (AP) view (called ‘AP distal FT’, P = 0.005), and the ratio between the distance from TT entrance to the talo-navicular joint and the talus length on lateral view (P = 0.009). Optimal thresholds were of >35 mm and < 0.445, respectively. At multivariate anlysis, only ‘AP distal FT’ >35 mm remained independent predictor of good outcome (P = 0.002).Radiological evaluation of bone tunnels following AAR-LAL is feasible, reproducible, and helps predict short-term outcome after reconstruction of lateral ankle ligaments.