Arthroscopy for athletic foot and ankle injuries

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.

Benefits of arthroscopic tuberculoplasty in posterior ankle impingement syndrome

The purpose of this work was to describe the posterior ankle impingement syndrome related to the posterolateral tubercle of the talus bone and to present a retrospective analysis of our results after arthroscopic plasty of the tubercle in 15 ankles with a mean 3-year follow-up. Fifteen cases of posterior ankle impingement (PAI) underwent arthroscopic excision of an impinging bone spur. All the patients (13) were retrospectively evaluated at an average of 36 months after index surgery. There were seven women (bilateral in two of them) and six men. Ten were involved in different kinds of sport and three were professional ballet dancers. Preoperative symptoms included pain localized in the posterior ankle, limitation of motion, weakness and swelling. All patients had failed a course of conservative therapies. Surgery was performed through posterolateral and posteromedial portals as described by van Dijk. After soft tissue debridement, partial resection of the posterolateral process was performed until there was complete plantar flexion without bone impingement. Postoperatively, all patients followed the same rehabilitation protocol. Improvement in their impingement symptoms was recorded in all of them according to AOFAS score. One of them (7%) still had occasional discomfort. The results suggest that arthroscopic bone decompression of the posterolateral tubercle in cases of PAI resistant to non-surgical therapies is an effective treatment.

Arthroscopic excision of the talar Stieda's process

One of the causes of posterior ankle pain is posterior impingement syndrome. When the talar lateral process is long, in which case it is called Stieda's process, it may be impinged between the tibia and calcaneus. We report the case of a 19-year-old patient who complained of posterior ankle pain and was diagnosed with posterior impingement of Stieda's process. He failed to respond to conservative treatment and thus underwent arthroscopic excision. The ankle was approached through standard posterior lateral and trans-Achilles portals. A 4.5-mm diameter 30 degrees arthroscope was used. Soft tissues around the talus were cleared with the help of a motorized shaver; after this, the posterior aspect of the subtalar joint could be visualized. The Stieda's process was seen to impinge between the tibia and the calcaneus in forced plantar flexion. The talar process was removed with a burr until the impingement disappeared. The patient returned to contact sports 8 weeks after surgery. Arthroscopic excision of the lateral process of the talus can be accomplished easily and return to sports is achieved in a relatively short time.

Osteoarthritis in Other Joints (Hip, Elbow, Foot, Ankle, Toes, Wrist) after Sports Injuries

Osteoarthritis of nonknee joints, although less common than knee osteoarthritis, remains a significant and disabling condition for many present and former athletes. These injuries can be caused by repeated loads or following a specific traumatic event. The resulting pain and loss of motion can limit function and ability. Arthroscopic techniques in many cases enable surgeons to symptomatically treat limitations of range of motion and pain, prolonging active careers. Joint replacement remains the ultimate solution for hip osteoarthritis, and may be a viable option in ankle osteoarthritis.