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Abstract
Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced hyperplantarflexion. Posterior ankle impingement results from chronic, repetitive trauma to the posterior ankle capsule, flexor hallucis longus tendon, and/or os trigonum. It is important to perform a thorough workup by isolating and testing the posterior compartment muscles and obtaining proper imaging with radiographs to identify any osseous abnormalities and MRI to evaluate the soft tissue structures. Nonsurgical treatment includes activity modification, physical therapy, and steroid injections.
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Affiliation(s)
- Megan A Ishibashi
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA.
| | - Craig E Krcal
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 3600 Broadway, Oakland, CA 94611, USA
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Maffulli N, Aicale R, Migliorini F, Wagner E, Saxena A, Oliva F. The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes. J Orthop Traumatol 2022; 23:28. [PMID: 35794371 PMCID: PMC9259767 DOI: 10.1186/s10195-022-00651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS. Methods Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months. Results The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (p < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (p < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure. Conclusion Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni Di Dio E Ruggi D'Aragona, 84131, Salerno, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni Di Dio E Ruggi D'Aragona, 84131, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH University Hospital, RWTH Aachen University Clinic, Pauwelsstraße 30, 51074, Aachen, Germany.
| | - Emilio Wagner
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH University Hospital, RWTH Aachen University Clinic, Pauwelsstraße 30, 51074, Aachen, Germany
| | - Amol Saxena
- Department of Foot and Surgery, Universidad del Desarrollo, Clínica Alemana, Santiago, Chile.,Department of Sports Medicine, Sutter-Palo Alto, Palo Alto, CA, United States
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni Di Dio E Ruggi D'Aragona, 84131, Salerno, Italy
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Zwiers R, Miedema T, Wiegerinck JI, Blankevoort L, van Dijk CN. Open Versus Endoscopic Surgical Treatment of Posterior Ankle Impingement: A Meta-analysis. Am J Sports Med 2022; 50:563-575. [PMID: 34048272 DOI: 10.1177/03635465211004977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment of symptomatic posterior ankle impingement consists of resection of the bony impediment and/or debridement of soft tissue. Historically, open techniques were used to perform surgery with good results. However, since the introduction of endoscopic techniques, advantages attributed to these techniques are shorter recovery time, fewer complications, and less pain. PURPOSE The primary purpose was to determine whether endoscopic surgery for posterior ankle impingement was superior to open surgery in terms of functional outcome (American Orthopaedic Foot & Ankle Society [AOFAS] score). The secondary aim was to determine differences in return to full activity, patient satisfaction, and complications. STUDY DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE (Classic), and CINAHL databases were searched. Publication characteristics, patient characteristics, surgical techniques, AOFAS scores, time to return to full activity, patient satisfaction, and complication rates were extracted. The AOFAS score was the primary outcome measure. Data were synthesized, and continuous outcome measures (postoperative AOFAS score and time to return to full activity) were pooled using a random-effects inverse variance method. Random-effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients who were satisfied and who experienced complications. RESULTS A total of 32 studies were included in this review. No statistically significant difference was found in postoperative AOFAS scores between open surgery (88.0; 95% CI, 82.1-94.4) and endoscopic surgery (94.4; 95% CI, 93.1-95.7). There was no difference in the proportion of patients who rated their satisfaction as good or excellent, 0.91 (95% CI, 0.86-0.96) versus 0.86 (95% CI, 0.79-0.94), respectively. No significant difference in time to return to activity was found, 10.8 weeks (95% CI, 7.4-15.9 weeks) versus 8.9 weeks (95% CI, 7.6-10.4 weeks), respectively. Pooled proportions of patients with postoperative complications were 0.15 (95% CI, 0.11-0.19) for open surgery versus 0.08 (95% CI, 0.05-0.14) for endoscopic surgery. Without the poor-quality studies, this difference was statistically significant for both total and minor complications, 0.24 (95% CI, 0.14-0.35) versus 0.02 (95% CI, 0.00-0.06) and 0.14 (95% CI, 0.09-0.20) versus 0.03 (95% CI, 0.01-0.05), respectively. CONCLUSION We found no statistically significant difference in postoperative AOFAS scores, patient satisfaction, and return to preinjury level of activity between open and endoscopic techniques. The proportion of patients who experienced a minor complication was significantly lower with endoscopic treatment when studies of poor methodological quality were excluded.
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Affiliation(s)
- Ruben Zwiers
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Thymen Miedema
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Johannes I Wiegerinck
- Department of Orthopaedic Surgery, Bergman Clinics, Naarden, Amsterdam, the Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - C Niek van Dijk
- FIFA Medical Centre of Excellence Ripoll-dePrado-vanDijk SportClinic Madrid, Spain.,FIFA Medical Centre of Excellence Clinica do Dragao Porto, Portugal
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Five-year follow-up of endoscopic resection of symptomatic os trigonum: a prospective interventional cohort study of a possible cause of ankle and big toe pain. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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THE OPERATIVE TREATMENT OUTCOMES OF CHRONIC HINDFOOT PAIN WITH POSTERIOR ANKLE ENDOSCOPY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2021. [DOI: 10.33457/ijhsrp.888804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sharpe BD, Steginsky BD, Suhling M, Vora A. Posterior Ankle Impingement and Flexor Hallucis Longus Pathology. Clin Sports Med 2020; 39:911-930. [PMID: 32892975 DOI: 10.1016/j.csm.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Posterior ankle pain is a common complaint, and the potential causative pathologic processes are diverse. The constellation of these numerous etiologies has been collectively referred to as posterior ankle impingement syndrome. The pain associated with posterior ankle impingement is caused by bony or soft tissue impingement of the posterior ankle while in terminal plantar flexion. This condition is most frequently encountered in athletes who participate in sports that involve forceful, or repetitive, ankle plantar flexion. This article discusses the associated pathology, diagnosis, conservative treatment, and surgical techniques associated with flexor hallucis longus and posterior ankle impingement syndrome.
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Affiliation(s)
- B Dale Sharpe
- Residency Program, OhioHealth Orthopedic Surgery, 5100 West Broad Street, Columbus, OH 43228, USA
| | - Brian D Steginsky
- OhioHealth Orthopedic Surgeons, 303 East Town Street, Columbus, OH 43215, USA.
| | - Mallory Suhling
- Illinois Bone and Joint Institute, LLC, 720 Florsheim Drive, Libertyville, IL 60048, USA
| | - Anand Vora
- Illinois Bone and Joint Institute, LLC, 720 Florsheim Drive, Libertyville, IL 60048, USA
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Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum. Case Rep Orthop 2020; 2020:6236302. [PMID: 32280550 PMCID: PMC7140132 DOI: 10.1155/2020/6236302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/14/2020] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of massive accumulation of fluid in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum. A 34-year-old woman presented to our hospital with pain and swelling in the posteromedial aspect of the left ankle joint after an ankle sprain approximately 8 months earlier. There was tenderness at the posteromedial aspect of the ankle, and the pain worsened on dorsiflexion of the left great toe. Magnetic resonance imaging revealed massive accumulation of fluid around the flexor hallucis longus tendon. We removed the os trigonum, performed tenosynovectomy around the flexor hallucis longus, and released the flexor hallucis longus tendon via posterior arthroscopy using standard posterolateral and posteromedial portals. At 1 week postoperatively, the patient was asymptomatic and able to resume her daily activities. There has been no recurrence of the massive accumulation of fluid around the flexor hallucis longus tendon as of 1 year after the surgery. To our knowledge, this is a rare case report of extreme massive effusion in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum treated successfully by removal of the os trigonum, tenosynovectomy around the flexor hallucis longus, and release of the flexor hallucis longus tendon via posterior ankle arthroscopy.
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Heyer JH, Dai AZ, Rose DJ. Excision of Os Trigonum in Dancers via an Open Posteromedial Approach. JBJS Essent Surg Tech 2018; 8:e31. [PMID: 30775136 DOI: 10.2106/jbjs.st.18.00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Surgical excision is indicated on failure of nonoperative management. Options for surgical excision include open excision (via a posterolateral or posteromedial approach), subtalar arthroscopy, and posterior endoscopy. Os trigonum excision via an open posteromedial approach with concomitant FHL tenolysis/tenosynovectomy is a safe and effective method for the operative treatment of a symptomatic os trigonum that allows for identification and treatment of associated FHL pathology. The major steps in the procedure, which are demonstrated in this video article, are: (1) preoperative planning with appropriate imaging; (2) patient is positioned in a supine position with the operative extremity in figure-of-4 position; (3) a 3-cm, slightly curvilinear longitudinal incision is made midway between the posterior aspect of the medial malleolus and the anterior aspect of the Achilles tendon, over the palpated FHL tendon, and the flexor retinaculum is exposed and incised; the neurovascular bundle is retracted anteriorly, exposing the FHL tendon and sheath; (4) FHL tenolysis/tenosynovectomy is performed; (5) the FHL is retracted anteriorly and a capsulotomy is performed over the os trigonum and the os trigonum is excised; (6) the capsule is repaired and closure is performed; and (7) dressings and a CAM (controlled ankle motion) walking boot are applied. The patient begins physical therapy at 2 weeks postoperatively and may return to dance at 4 to 6 weeks postoperatively as tolerated. In our series of 40 cases, 95% of patients who desired to return to dance were able to return to their pre-injury level of dance. There were no major neurovascular complications.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Amos Z Dai
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Donald J Rose
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F. Ankle Arthroscopy: An Update. J Bone Joint Surg Am 2017; 99:1395-1407. [PMID: 28816902 DOI: 10.2106/jbjs.16.00046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jordi Vega
- 1Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain 2Human Anatomy and Embriology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain 3Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Spain 4Foot and Ankle Unit, Department of Orthopaedic Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, United Kingdom 5Foot and Ankle Unit, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process. INTERNATIONAL ORTHOPAEDICS 2017; 41:1585-1592. [DOI: 10.1007/s00264-017-3489-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/18/2017] [Indexed: 12/18/2022]
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Georgiannos D, Bisbinas I. Endoscopic Versus Open Excision of Os Trigonum for the Treatment of Posterior Ankle Impingement Syndrome in an Athletic Population: A Randomized Controlled Study With 5-Year Follow-up. Am J Sports Med 2017; 45:1388-1394. [PMID: 28113040 DOI: 10.1177/0363546516682498] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Open surgical excision of the os trigonum has been the traditional treatment for posterior ankle impingement syndrome (PAIS). However, the endoscopic excision has recently become quite popular. Purpose/Hypothesis: The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in an athletic population. It was hypothesized that the endoscopic technique would be superior to the open technique regarding functional outcomes, pain, and time to return to training and the previous sports level. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision; 26 athletes had an open procedure (group A) and 26 had an endoscopic procedure (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Visual Analog Score-Foot and Ankle (VAS-FA) were obtained, and the time to return to training and to previous sports level was recorded. RESULTS Patients in group B appeared to have significant improvement of AOFAS hindfoot score compared with those in group A ( P < .05), whereas no statistical significance was found for the postoperative VAS-FA scores between the 2 groups. The mean ± SD time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B ( P < .001). The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B ( P < .001). The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (1 case). CONCLUSION Both the open procedure and the endoscopic approach yielded acceptable outcomes in terms of function and pain. However, complication rates were remarkably lower with endoscopic treatment, and the time to return to full activities was much shorter. Endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who require early return to their previous sports level.
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12
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Abstract
BACKGROUND An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Options for operative excision include open excision, subtalar arthroscopy, and posterior endoscopy. The purpose of this paper was to present a series of dancers who underwent excision of a symptomatic os trigonum via an open posteromedial approach. METHODS This study is a retrospective case series of 40 ankles in 38 dancers who underwent os trigonum excision via an open posteromedial approach with FHL tenolysis between 2000 and 2013. All patients were interviewed and charts retrospectively analyzed. Collected variables included pre- and postoperative pain level, time to return to dance, and subjective satisfaction. The average age was 19.2 years; ballet was the primary dance form in 36 (95%) of patient-cases. Eight (20%) of the patient-cases were professional dancers, and 30 (75%) were students or preprofessional dancers. RESULTS Average preoperative pain level was 7.7/10, which decreased to 0.6/10 postoperatively. Seventeen (42.5%) experienced concurrent preoperation-associated FHL symptomatology, all of whom experienced relief postoperatively. The average time to return to dance was 7.9 weeks, and time to pain-free dance was 17.7 weeks. Of the 37 patient-cases desiring to return to dance, 35 (94.6%) returned to their preoperative level of dance. There were no neurovascular or other major complications. Four (10%) had minor wound complications that resolved, and 38 cases (95%) considered the procedure a success. CONCLUSION Open posteromedial excision of an os trigonum in dancers provided satisfactory pain relief, return to dance, and complication rates compared to other approaches, and allowed for identifying and treating any associated FHL pathology. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jessica H Heyer
- 1 Orthopaedic Surgery Department, George Washington University Hospital, Washington, DC, USA
| | - Donald J Rose
- 2 Department of Orthopaedic Surgery, Harkness Center for Dance Injuries, New York University Hospital for Joint Diseases, New York, NY, USA
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13
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Yasui Y, Hannon CP, Hurley E, Kennedy JG. Posterior ankle impingement syndrome: A systematic four-stage approach. World J Orthop 2016; 7:657-663. [PMID: 27795947 PMCID: PMC5065672 DOI: 10.5312/wjo.v7.i10.657] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.
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14
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Abstract
Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.
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Affiliation(s)
- Kyle P Lavery
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Kevin J McHale
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - William H Rossy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - George Theodore
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
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Carreira DS, Vora AM, Hearne KL, Kozy J. Outcome of Arthroscopic Treatment of Posterior Impingement of the Ankle. Foot Ankle Int 2016; 37:394-400. [PMID: 26646107 DOI: 10.1177/1071100715620857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open and arthroscopic techniques have been utilized in the treatment of posterior impingement of the ankle and hindfoot. Because posterior impingement occurs more frequently in patients who repetitively plantarflex the ankle, this population may especially benefit from a procedure that reduces pain and results in maximal range of motion (ROM). The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with posterior ankle impingement through a higher level of function outcome measures and physical examination parameters, focused on analysis of ROM. METHODS Twenty patients were followed prospectively at a minimum 1-year follow-up (mean 38.2 months). Nineteen of 20 patients were competitive athletes. Patients completed a minimum of 3 months of nonoperative treatment. Diagnoses included os trigonum, tibial exostosis, talar exostosis, loose body or fracture nonunion, and ganglion cyst removal. Patients underwent arthroscopic treatment utilizing a posterior approach; all relevant pathology was addressed. RESULTS At the most recent follow-up, visual analog scale pain and American Orthopaedic Foot & Ankle Society hindfoot scores showed significant improvement (P < .01) pre- to postoperatively; Tegner score remained unchanged (P = .888). Three patients were professional athletes; all returned to their previous level of professional activity. ROM variables between affected and unaffected sides reached statistical similarity at the most recent follow-up. Only ankle plantarflexion reached statistical significance when compared pre- to postoperatively. Fifteen percent of patients reported postoperative neuritis. CONCLUSIONS Posterior ankle arthroscopy allowed for maintenance or restoration of anatomic ROM of the ankle and hindfoot, ability to return to at least previous level of activity, and improvement in objective assessment of pain relief and higher level of function parameters. Complications associated with this procedure were minimal. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Dominic S Carreira
- Broward Health Sports Medicine and Orthopedics, Fort Lauderdale, FL, USA
| | - Anand Mahesh Vora
- Illinois Bone & Joint Institute, University of Illinois, Chicago, IL, USA
| | - Kelly L Hearne
- Broward Health Sports Medicine and Orthopedics, Fort Lauderdale, FL, USA
| | - John Kozy
- Broward Health Sports Medicine and Orthopedics, Fort Lauderdale, FL, USA
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Evidence-based indications for hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1386-95. [PMID: 26744282 DOI: 10.1007/s00167-015-3965-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/23/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The 2-portal hindfoot endoscopic technique with the patient in prone position, first introduced by van Dijk et al. (Arthroscopy 16:871-876, 2000), is currently the most used by foot and ankle surgeons to address endoscopically pathologies located in the hindfoot. This article aims to review the literature to provide a comprehensive description of the level of evidence available to support the use of the 2-portal hindfoot endoscopy technique for the current generally accepted indications. METHODS A comprehensive review was performed by use of the PubMed database to isolate literature that described therapeutic studies investigating the results of different hindfoot endoscopy treatment techniques. All articles were reviewed and assigned a classification (I-V) of level of evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for hindfoot endoscopy. A subscale was used to further describe the evidence base for indications receiving a grade of recommendation indicating poor-quality evidence. RESULTS On the basis on the available evidence, posterior ankle impingement syndrome, subtalar arthritis and retrocalcaneal bursitis have the strongest recommendation in favour of treatment (grade Cf). CONCLUSION Although a low level of evidence of the included studies, the review showed that adequate literature to support the use of the 2-portal endoscopic techniques for most currently accepted indications exists. Future "higher quality" evidence could strengthen current recommendations and further help surgeons in evidence-based practice. LEVEL OF EVIDENCE Level V, Review of Level III, IV and V studies.
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Endoscopic treatment of the posterior ankle impingement syndrome on amateur and professional athletes. Knee Surg Sports Traumatol Arthrosc 2016; 24:1396-401. [PMID: 26264381 DOI: 10.1007/s00167-015-3747-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/30/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine whether professional and amateur athletes showed differences in ankle function when treated with endoscopic technique for posterior ankle impingement syndrome, to verify the impact of the presence of associated lesions in clinical evolution and to assess time to return to sport (we hypothesize that time will be the only difference between groups). METHODS Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedics Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The satisfaction, time to return to sport, operative time, intraoperative findings and complications were evaluated, and the presence of associated injuries interfering in these results was verified. RESULTS The preoperative AOFAS score range for the professional group was 62.9 ± 14 preoperatively and 92.3 ± 7.7 postoperatively, and for the amateur group was 67.9 ± 19.7 and 94 ± 9.3. The satisfaction was excellent or good in 94 % of all cases and fair in 6%. The average time of surgery was 48.3 + 25 min. Bone involvement was present in 100% of cases and complications in three cases. Time to return to sports was similar (n.s.) in both groups, and the mean time was 15.6 ± 13.7 and 16.3 ± 9 weeks, respectively. CONCLUSION No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Athletes showed mainly good and excellent results and low complication rate. The presence of associated injuries did not significantly influence the results. With these results, the high-level athlete can better programme their surgeries so they can fully recover and perform better in the most important competitions. LEVEL OF EVIDENCE Level III.
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Funasaki H, Hayashi H, Sakamoto K, Tsuruga R, Marumo K. Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance. Arthrosc Tech 2015; 4:e769-74. [PMID: 27284509 PMCID: PMC4886817 DOI: 10.1016/j.eats.2015.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023] Open
Abstract
Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30° arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers.
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Affiliation(s)
- Hiroki Funasaki
- Address correspondence to Hiroki Funasaki, M.D., Department of Sports and Wellness Clinic, Jikei University School of Medicine, 3-25-8 Nishishinbashi Minato-ku, Tokyo 105-8461, Japan.
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Correia SI, Silva-Correia J, Pereira H, Canadas RF, da Silva Morais A, Frias AM, Sousa RA, van Dijk CN, Espregueira-Mendes J, Reis RL, Oliveira JM. Posterior talar process as a suitable cell source for treatment of cartilage and osteochondral defects of the talus. J Tissue Eng Regen Med 2015; 11:1949-1962. [DOI: 10.1002/term.2092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/09/2015] [Indexed: 01/20/2023]
Affiliation(s)
- S. I. Correia
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - J. Silva-Correia
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - H. Pereira
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
- Clínica do Dragão - Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, F.C. Porto Stadium; Minho University and Porto University Research Centre; Portugal
- Orthopaedic Department Centro Hospitalar Póvoa de Varzim; Vila do Conde Portugal
| | - R. F. Canadas
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - A. da Silva Morais
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - A. M. Frias
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; 4805-017 Guimarães Portugal
| | - R. A. Sousa
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; 4805-017 Guimarães Portugal
| | - C. N. van Dijk
- Clínica do Dragão - Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, F.C. Porto Stadium; Minho University and Porto University Research Centre; Portugal
- Orthopaedic Department; Amsterdam Medical Centre; The Netherlands
| | - J. Espregueira-Mendes
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
- Clínica do Dragão - Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, F.C. Porto Stadium; Minho University and Porto University Research Centre; Portugal
| | - R. L. Reis
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - J. M. Oliveira
- 3Bs Research Group, Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark 4805-017 Barco Guimarães Portugal
- ICVS/3Bs; PT Government Associate Laboratory; Braga/Guimarães Portugal
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Rungprai C, Tennant JN, Phisitkul P. Disorders of the Flexor Hallucis Longus and Os Trigonum. Clin Sports Med 2015; 34:741-59. [PMID: 26409593 DOI: 10.1016/j.csm.2015.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Os trigonum syndrome with disease of the flexor hallucis longus tendon, so-called stenosing flexor tenosynovitis, is a common cause of posterior ankle impingement. Conservative treatment is the recommended first line of treatment, with secondary treatment options of either open or arthroscopic os trigonum excision with flexor hallucis longus retinaculum release. The arthroscopic approaches have gained popularity in the past decade because of less scarring, less postoperative pain, minimal overall morbidity, and earlier return to activities. However, comprehensive understanding of the anatomy of the posterior ankle is crucial to warrant successful outcomes and minimizing complications.
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Affiliation(s)
- Chamnanni Rungprai
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Bangkok 10400, Thailand
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina School of Medicine, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27514, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Miyamoto W, Takao M, Matsushita T. Hindfoot endoscopy for posterior ankle impingement syndrome and flexor hallucis longus tendon disorders. Foot Ankle Clin 2015; 20:139-47. [PMID: 25726489 DOI: 10.1016/j.fcl.2014.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hindfoot endoscopic surgery is an alternative to conventional open surgery for treatment of posterior ankle pain. This procedure can be applied not only for accurate diagnosis under direct visualization but also for low-invasive therapy. Common indications for hindfoot endoscopy are posterior ankle impingement syndrome and damaged soft tissue. Several studies have reported good clinical outcomes of hindfoot endoscopy with lower complication rates than in the conventional open procedure. Nerve injury remains a common complication. To avoid such injury, make a posterolateral portal just lateral to the Achilles tendon and perform the hindfoot endoscopic procedure in the region lateral to the flexor hallucis longus tendon.
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Affiliation(s)
- Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan.
| | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan
| | - Takashi Matsushita
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan
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Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique. Foot Ankle Surg 2014; 20:174-9. [PMID: 25103704 DOI: 10.1016/j.fas.2014.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/03/2014] [Accepted: 03/13/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Posterior ankle impingement is a clinical syndrome characterized by posterior ankle pain that is mainly presented on plantar flexion. The aim of this study is to compare and evaluate the results of posterior ankle impingement treated by endoscopic hindfoot posterior portals. MATERIALS AND METHODS Between 2004 and 2009, a total of 38 endoscopic hindfoot procedures were performed to treat posterior ankle impingement. The indication for procedure was posterior ankle impingement syndrome in all cases. There were 38 patients, 17 females and 21 males. Mean age was 27.6 years (16-59 years). Mean follow-up was 27.6 months (12.5-52 months). The results were evaluated following the AOFAS score. Data statistical analysis was performed using the Student's t-test. RESULTS The main preoperative AOFAS score increased from 67.42 (range 41-91) to 97.13 (range 84-100) at follow-up. No complications were reported in any case. CONCLUSION Hindfoot endoscopy is a reproducible and safe procedure which offers excellent outcomes in posterior ankle impingement syndrome.
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Abstract
Os trigonum syndrome is the result of an overuse injury of the posterior ankle caused by repetitive plantar flexion stress. It is predominantly seen in ballet dancers and soccer players and is primarily a clinical diagnosis of exacerbated posterior ankle pain while dancing on pointe or demi-pointe or while doing push-off maneuvers. Symptoms may improve with rest or activity modification. Imaging studies, including a lateral radiographic view of the ankle in maximal plantar flexion, will typically reveal the os trigonum between the posterior tibial lip and calcaneus. If an os trigonum is absent on radiography, an MRI may reveal scar tissue behind the posterior talus, a condition associated with similar symptoms. Os trigonum syndrome is often associated with pathology of the flexor hallucis longus tendon. Treatment begins with nonsurgical measures. In addition to physical therapy, symptomatic athletes may need surgical excision of os trigonum secondary to unavoidable plantar flexion associated with their sport. This surgery can be performed using open or arthroscopic approaches.
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The incidence of complications after posterior hindfoot endoscopy. Arthroscopy 2013; 29:2049-54. [PMID: 24286803 DOI: 10.1016/j.arthro.2013.08.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to determine the incidence of complications after posterior hindfoot endoscopy. METHODS Ovid/Medline and Google Scholar were systematically searched for pertinent references to be included. In addition, we hand-searched common American and European orthopaedic and podiatric surgical journals for relevant articles. Articles considered for inclusion were published in peer-reviewed journals, described complications after posterior hindfoot endoscopy using a standard 2-portal technique, and involved 25 or more patients treated. RESULTS We identified 335 potentially relevant publications, of which 5 met our inclusion criteria. A total of 452 ankles (452 patients) were included in this study. Overall, 17 complications (3.8%) occurred, with only 8 (1.8%) requiring additional treatment or operative intervention. CONCLUSIONS The endoscopic approach for the treatment of hindfoot and ankle pathology is safe with a low incidence of complications. However, additional studies with prospective designs should be undertaken to determine the long-term patient outcomes using validated scoring systems. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Surgical treatment for posterior ankle impingement. Arthroscopy 2013; 29:1263-70. [PMID: 23541613 DOI: 10.1016/j.arthro.2013.01.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aims to provide an overview of both the open and endoscopic procedures used to treat posterior ankle impingement, as well as an analysis, evaluation, and comparison of their outcomes. METHODS A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases and the Cochrane Database of Clinical and Randomized Controlled Trials was performed. Quality of included studies was assessed by use of the Downs and Black scale. RESULTS After we reviewed 783 studies, 16 trials met the inclusion criteria. Of these trials, 6 reported on open surgical techniques and 10 evaluated endoscopic techniques. The complication rate (15.9% v 7.2%) and time to return to full activity (16.0 weeks v 11.3 weeks) differed between the 2 groups, both favoring endoscopic surgery. CONCLUSIONS Although the level of evidence of the included studies is relatively low, it can be concluded that the endoscopic technique is superior to the open procedure. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Abstract
Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10,000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.
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Ogut T, Ayhan E, Irgit K, Sarikaya AI. Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 2011; 19:1355-61. [PMID: 21311860 DOI: 10.1007/s00167-011-1428-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 01/27/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study is to describe the indications for two-portal hindfoot endoscopy in the treatment of posterior ankle compartment pathologies and to express the effectiveness of this technique by short- to mid-term outcomes on 59 consecutive patients. METHODS In our institute, between 2003 and 2009, patients operated by single surgeon with hindfoot endoscopy were enrolled. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and Maryland foot scores (MFS) were obtained preoperatively and postoperatively. In the final follow-up, besides the scores, patients were asked whether they were satisfied and whether they would elect this treatment again. RESULTS The indications for 59 patients were posterior ankle impingement syndrome (14), osteochondral lesion of talus (13), isolated flexor hallucis longus (FHL) tenosynovitis (11), synovial osteochondromatosis (2), pigmented villonodular synovitis (2), peroneal tenosynovitis (4), subtalar joint arthrosis (4), tibiotalar arthrosis (4), intraosseous talus cyst (4; 1 bilateral), and talus fracture (1). FHL tendon was affected in all cases, and tenolysis was performed for each patient. The mean preoperative AOFAS-hindfoot scores increased from 56.7 ± 14.5 to 85.9 ± 12.5 (P < 0.0001), and the mean preoperative MFS increased from 54.8 ± 17.5 to 84.9 ± 15.9 (P < 0.0001), postoperatively. Four patients with posttraumatic arthritis were dissatisfied. Two sural nerve-related complications were identified. DISCUSSION Hindfoot endoscopy was demonstrated to be a safe and effective procedure for the treatment of various hindfoot pathologies in this cohort, excluding patients with posttraumatic arthritis. Our results show that the prevalence of FHL tenosynovitis may be higher than previously reported and should always be considered in differential diagnosis of posteromedial ankle pain. LEVEL OF EVIDENCE Case series with no comparison group, Level IV.
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Affiliation(s)
- Tahir Ogut
- Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Istanbul University, Istanbul, Turkey
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Russell JA, Kruse DW, Koutedakis Y, McEwan IM, Wyon MA. Pathoanatomy of posterior ankle impingement in ballet dancers. Clin Anat 2010; 23:613-21. [PMID: 20821398 DOI: 10.1002/ca.20991] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dance is a high performance athletic activity that leads to great numbers of injuries, particularly in the ankle region. One reason for this is the extreme range of ankle motion required of dancers, especially females in classical ballet where the en pointe and demi-pointe positions are common. These positions of maximal plantar flexion produce excessive force on the posterior ankle and may result in impingement, pain, and disability. Os trigonum and protruding lateral talar process are two common and well-documented morphological variations associated with posterior ankle impingement in ballet dancers. Other less well-known conditions, of both bony and soft tissue origins, can also elicit symptoms. This article reviews the anatomical causes of posterior ankle impingement that commonly affect ballet dancers with a view to equipping healthcare professionals for improved effectiveness in diagnosing and treating this pathology in a unique type of athlete.
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Affiliation(s)
- Jeffrey A Russell
- Department of Dance, University of California-Irvine, Irvine, California, USA.
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Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP. Evidence-based indications for ankle arthroscopy. Arthroscopy 2009; 25:1478-90. [PMID: 19962076 DOI: 10.1016/j.arthro.2009.05.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 05/05/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review the literature to provide a comprehensive description of the Level of Evidence available to support the surgical technique of ankle arthroscopy for the current generally accepted indications and assign a grade of recommendation for each of them. METHODS A comprehensive review of the literature was performed (in August 2008) by use of the PubMed database. The abstracts from these searches were reviewed to isolate literature that described therapeutic studies investigating the results of different ankle arthroscopic treatment techniques. All articles were reviewed and assigned a classification (I-IV) of Level of Evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for ankle arthroscopy. RESULTS There exists fair evidence-based literature (grade B) to support a recommendation for the use of ankle arthroscopy for the treatment of ankle impingement and osteochondral lesions and for ankle arthrodesis. Ankle arthroscopy for ankle instability, septic arthritis, arthrofibrosis, and removal of loose bodies is supported with only poor-quality evidence (grade C). Treatment of ankle arthritis, excluding isolated bony impingement, is not effective and therefore this indication is not recommended (grade C against). Finally, there is insufficient evidence-based literature to support or refute the benefit of arthroscopy for the management of synovitis and fractures (grade I). CONCLUSIONS There exists adequate evidence-based literature to support the surgical technique of ankle arthroscopy for most current generally accepted indications; however, further studies in this area are needed. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Mark A Glazebrook
- Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Posterior arthroscopic excision of bilateral posterior bony impingement syndrome of the ankle: a case report. Knee Surg Sports Traumatol Arthrosc 2008; 16:396-9. [PMID: 18270683 DOI: 10.1007/s00167-008-0491-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
The common cause of posterior ankle impingement syndrome (PAIS) is impingement of the os trigonum or talar posterior process. There were few reports of bilateral PAIS of the os trigonum, and bilateral PAIS of the talar posterior process has not been previously reported. The authors report the case of a 32-year-old man who was diagnosed with bilateral PAIS related to a prominent lateral tubercle of the talar posterior process, and who was treated by posterior arthroscopic excision through posterolateral and posteromedial portals in a prone position. His preoperative posterior ankle pain disappeared completely after surgery, and the patient returned to contact sports 3 months postoperatively.
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