Wu Hang, Li Qiang, Yuan Haitao, Gu Peng, Fan Shaoyong, Deng Xiongwei
Objective To explore the clinical efficacy of modified Brostrom surgery and plaster fixation in the conservative treatment of acute complete rupture of the anterior talofibular ligament (ATFL) and its influence on the plantar pressure distribution, and to compare it with healthy normal people, providing biomechanical basis for the selection of clinical treatment regimens. Methods A retrospective controlled study was conducted, and the clinical data of 60 patients with complete rupture of acute closed ATFL admitted in our hospital from June 2023 to December 2024 were included. The patients were divided into the surgical group (30 cases, receiving the modified Brostrom surgery) and the conservative group (30 cases, receiving plaster fixation) according to the treatment methods. Another 30 healthy volunteers were selected as the normal control group. The general data of the three groups were collected and compared. Before treatment and at the last follow-up, the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) for pain were used to evaluate ankle joint function and pain degree. The stability of the ankle joint was evaluated by measuring the talus tilt angle (TTA) and talus forward displacement (ATD) through stress position X-ray films. At the last follow-up, the plantar pressure distribution parameters of the three groups of subjects during walking were detected by the plantar pressure analysis system. Results All patients were followed up for 12 to 18 months, mean (14.2±2.1) months. After treatment, the AOFAS score, VAS score, TTA and ATD of both the surgical group and the conservative group were significantly improved compared with those before treatment (P<0.05). At the last follow-up, the AOFAS score of the surgical group was significantly higher than that of the conservative group (P<0.05), while the VAS score, TTA and ATD were significantly lower than those of the conservative group (P<0.05), and there was no statistically significant difference in each index between the surgical group and the normal control group (P>0.05). Plantar pressure analysis showed that compared with the normal control group, the peak pressure and pressure-time integral in the lateral area of the foot (the fifth metatarsal head and the fourth metatarsal head area) in the conservative group were significantly increased, while the parameters in the medial area of the foot (the first metatarsal head) were significantly decreased (P<0.05). The distribution of various plantar pressure parameters in the surgical group showed no statistically significant difference compared with the normal control group (P>0.05), and was significantly better than that in the conservative group (P<0.05). Conclusion For complete rupture of acute ATFL, the modified Brostrom surgery is superior to conservative treatment with plaster fixation in restoring ankle joint function and stability. Plantar pressure analysis indicates that surgical treatment can more effectively reconstruct the normal biomechanical environment of the foot, bringing the patient's gait pattern closer to a healthy and normal level, while there may be a persistent gait compensation mechanism after conservative treatment.However, conservative treatment remains a reasonable option for patients with low activity demands, mild instability, or high surgical risks, and clinical decisions should be individualized.