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Butler JJ, Randall GW, Dalmau-Pastor M, Lin CC, Schoof L, Kennedy JG. A hypertrophic distal fascicle of the anterior tibiofibular ligament is associated with a high rate of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39033348 DOI: 10.1002/ksa.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. METHODS Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. RESULTS Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. CONCLUSION This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- James J Butler
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Grace W Randall
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Charles C Lin
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Lauren Schoof
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - John G Kennedy
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
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2
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Gorbachova T, Saad SS, Pruna R, Melenevsky YV. Patterns of ankle injury in soccer: MRI clues to traumatic mechanism. Skeletal Radiol 2023:10.1007/s00256-023-04547-6. [PMID: 38157033 DOI: 10.1007/s00256-023-04547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
Understanding the traumatic mechanisms of ankle injuries in soccer is crucial for an accurate and complete MRI diagnosis. Many ankle injuries share universal mechanisms seen in other athletic activities, but certain patterns are found to be more specific and relatively unique to soccer. Ankle impingement syndromes encountered in soccer encompass a spectrum of disorders that include anterior and posterior impingement categories, with anterior impingement representing pathology relatively specific to soccer. Lateral ligamentous sprains are one of the most common injuries; however, there is a higher rate of injuries to the medial structures in soccer as compared to other sports. Ankle fractures are uncommon in soccer while bone contusions and chondral and osteochondral injuries frequently accompany ligamentous sprains. Tendon abnormalities in soccer most commonly result from overuse injuries and typically affect peroneal tendons, posterior and anterior tibialis tendons, and Achilles tendon. Acute Achilles tendon ruptures occur in both recreational players and elite soccer athletes. Tibialis anterior friction syndrome may mimic tibial stress fractures. Long-term sequelae of acute traumatic and chronic overuse ankle injuries in professional soccer players manifest as ankle osteoarthritis that is more prevalent compared to not only the general population, but also to former elite athletes from other sports. This article examines the most common and specific injuries in soccer in order of their frequency.
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Affiliation(s)
- Tetyana Gorbachova
- Department of Radiology, Jefferson Einstein, 5501 Old York Road, Levy building, Philadelphia, PA, 19141, USA.
| | - Sherif S Saad
- Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ, USA
| | - Ricard Pruna
- FC Barcelona Medical Department, Barcelona, Spain
| | - Yulia V Melenevsky
- Department of Radiology, University of Alabama at Birmingham, UAB Medical Center, Birmingham, AL, USA
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3
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Armstrong TM, Rowbotham E, Robinson P. Update on Ankle and Foot Impingement. Semin Musculoskelet Radiol 2023; 27:256-268. [PMID: 37230126 DOI: 10.1055/s-0043-1764387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ankle impingement syndromes are a well-recognized cause of chronic ankle symptoms in both the elite athletic and general population. They comprise several distinct clinical entities with associated radiologic findings. Originally described in the 1950s, advances in magnetic resonance imaging (MRI) and ultrasonography have allowed musculoskeletal (MSK) radiologists to further their understanding of these syndromes and the range of imaging-associated features. Many subtypes of ankle impingement syndromes have been described, and precise terminology is critical to carefully separate these conditions and thus guide treatment options. These are divided broadly into intra-articular and extra-articular types, as well as location around the ankle. Although MSK radiologists should be aware of these conditions, the diagnosis remains largely clinical, with plain film or MRI used to confirm the diagnosis or assess a surgical/treatment target. The ankle impingement syndromes are a heterogeneous group of conditions, and care must be taken not to overcall findings. The clinical context remains paramount. Treatment considerations are patient symptoms, examination, and imaging findings, in addition to the patient's desired level of physical activity.
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Affiliation(s)
- T M Armstrong
- Royal Free Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily Rowbotham
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - Philip Robinson
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
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4
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Cerezal A, Ocampo R, Llopis E, Cerezal L. Ankle Instability Update. Semin Musculoskelet Radiol 2023; 27:231-244. [PMID: 37230124 DOI: 10.1055/s-0043-1767767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
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Affiliation(s)
- Alvaro Cerezal
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ronald Ocampo
- Department of Radiology, Hospital de Trauma del Instituto Nacional de Seguros, San Jose, Costa Rica
| | - Eva Llopis
- Department of Radiology, Hospital IMSKE, Hospital de la Ribera, Valencia, Spain
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
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5
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Ogut E. The Stieda process of the talus: the anatomical knowledge and clinical significance of an overlooked protrusion. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:280. [DOI: https:/doi.org/10.1186/s42269-022-00968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/07/2022] [Indexed: 07/22/2023]
Abstract
Abstract
Background
The Stieda process (SP) is an extended lateral tubercle of the posterior process of the talus. Although there are different classifications for SP in the literature, it is essential to know the differential diagnosis of SP from fractures and accessory ossicles. This review aims to classify the SP and to guide the formation, prevalence, etiopathology, symptoms, differential diagnosis, and treatment.
Main body of the abstract
The authors conducted a literature review that lasted up to September 2022 and used the databases PubMed, Web of Science, and Google Scholar to explore the SP of the talus in all of its aspects. Out of 3802 publications, only 34 could be included, and most of them were studies on posterior ankle impingement syndrome (PAIS). The occurrence, prevalence, etiopathology, clinical significance, symptoms, differential diagnosis, and treatment methods of SP were investigated based on the literature. SP is formed by the fusion of a secondary ossification center at the posterolateral side of the talus with an incidence of 12–36.5%. It is frequently observed in males. It causes reduced plantar flexion, impairment in the inversion of the foot, pain, and swelling in the posterior ankle joint, PAIS, and SP fractures after trauma.
Short conclusion
SP can be diagnosed by lateral ankle radiography or MRI in patients complaining of PAIS. The initial treatment of the SP should include reducing inflammation, swelling, pain, and limiting activities. If neither modality affects the patient, surgical treatment will be performed, and SP will be resected until the impingement disappears.
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6
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Rui Xiang T, Zhen Ning Y, Oon Thien Kevin K. Two-Year Outcomes of Posterior Ankle Arthroscopy: A Case Series. Foot Ankle Spec 2022; 15:556-562. [PMID: 33435736 DOI: 10.1177/1938640020985822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the outcomes and complications after posterior ankle arthroscopy for the treatment of posterior ankle impingement syndrome, in a local population with a single surgeon series. Two-portal posterior ankle or hindfoot arthroscopy is an alternative option to open surgery in cases of posterior ankle impingement, that showed similar results but with less morbidity and faster recovery. There has been increasing interest in minimally invasive surgical techniques. Indications include extra- and intra-articular conditions and range from bony, cartilaginous to soft tissue pathology. Posterior ankle arthroscopy has been shown to be a good option in cases that are refractory to a period of conservative therapy. Posterior ankle arthroscopy also has known complications of sural nerve damage laterally and neurovascular bundle injury medially and also a steep learning curve that has been studied in the context of os trigonum excision. There have been few or no studies on the local Singaporean population and this article seeks to describe the various indications, results, and complications in the local Singaporean population by a single surgeon.Levels of Evidence: Level IV: Case series.
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Affiliation(s)
| | - Yeo Zhen Ning
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Utturkar AA, Ditzler MG, Schallert EK, Jadhav SP, Smith BG, Gladstein AZ, Kan JH. Pediatric Bassett's ligament: pathology or normal anatomy? Pediatr Radiol 2021; 51:1237-1242. [PMID: 33595702 DOI: 10.1007/s00247-020-04942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bassett's ligament is an accessory fascicle of the anterior inferior tibiofibular ligament. The prevalence, normal thickness and clinical implications of a thickened ligament have not been described in the pediatric radiology literature. OBJECTIVE The purpose of this study was to determine the prevalence and thickness of Bassett's ligament in pediatric patients with magnetic resonance imaging (MRI) findings of lateral talar osteochondral lesions, medial talar osteochondral lesions and posterior ankle impingement, to compare these measurements with normal MRIs, and to compare the reproducibility of these measurements. MATERIALS AND METHODS This is a retrospective study of pediatric ankle MRIs with four cohorts containing 21 patients each. All MRIs were retrospectively reviewed by a pediatric musculoskeletal radiologist and a pediatric radiology fellow. The prevalence of Bassett's ligament and its axial thickness were obtained for each cohort with repeat measurements for intra-observer and interobserver variability. Average thickness and standard deviation of Bassett's ligament were calculated. RESULTS The prevalence of Bassett's ligament and its thickness in each cohort were (mean±standard deviation): lateral osteochondral lesions, 71% (15/21), 1.9±0.5 mm; medial osteochondral lesions, 52% (11/21), 1.4±0.2 mm; posterior impingement, 52% (11/21), 1.3±0.2 mm; and normal ankle examinations, 71% (15/21), 1.5±0.4 mm. The thickness of Bassett's ligament was increased in the lateral talar osteochondral lesion group when compared to normal (P=0.02), while thickness in the medial osteochondral lesion and posterior impingement groups was not significant when compared to normal. The repeat measurements showed no significant difference in intra-observer and interobserver variability. CONCLUSION Bassett's ligament is a normal structure in children. Thickening of Bassett's ligament is seen with lateral osteochondral lesions and may be an indirect sign of anterolateral tibiotalar capsule injury.
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Affiliation(s)
- Atul A Utturkar
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
| | - Matthew G Ditzler
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Erica K Schallert
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Brian G Smith
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Aharon Z Gladstein
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - J Herman Kan
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
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8
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Diniz P, Sousa DA, Batista JP, Abdelatif N, Pereira H. Diagnosis and treatment of anterior ankle impingement: state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Impingement syndromes of the ankle and hindfoot. Pediatr Radiol 2019; 49:1691-1701. [PMID: 31686174 DOI: 10.1007/s00247-019-04459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/02/2019] [Accepted: 06/18/2019] [Indexed: 10/25/2022]
Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft-tissue or osseous abnormality affecting the tibiotalar joint or extraarticular soft tissues. Impingement can be associated with a prior single traumatic event or repetitive microtrauma, often in an adolescent with anatomical predisposition. Impingement syndromes at the tibiotalar joint can be subdivided into anterior, anterolateral, anteromedial, posterior or posteromedial. Extraarticular impingement can consist of talocalcaneal or subfibular impingement. Impingement syndromes are just one possible etiology of persistent ankle pain, and although the diagnosis is often made or suspected clinically, the radiologist might be the first person to raise the possibility of the diagnosis or be called upon to provide support for the clinically suspected diagnosis. In this article I review the etiology, imaging findings and current treatment associated with these conditions.
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10
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Morphological features of the inferior fascicle of the anterior inferior tibiofibular ligament. Sci Rep 2019; 9:10472. [PMID: 31320721 PMCID: PMC6639362 DOI: 10.1038/s41598-019-46973-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
In this study, the inferior fascicle of the anterior inferior tibiofibular ligament (AITFL) was classified to provide basic information to help elucidate the mechanism of ankle joint anterolateral impingement, and the morphological features of each type were compared for the purpose of clarification. This investigation examined 100 feet from 52 cadavers. The AITFL was classified into four types according to the presence or absence of the inferior fascicle and the positional relationship between the AITFL and the inferior fascicle of the AITFL. The morphological features of the AITFL that were measured included the fibre bundle length, fibre bundle width, fibre bundle angle, and the distance between the joint levels. A distinct, independent inferior fascicle of the AITFL was identified in 15 feet (15%). There were no significant differences in the morphological features based on differences in the AITFL classification. Therefore, these findings suggest that the presence or absence of the inferior fascicle and the difference in the positional relationship between the AITFL and the inferior fascicle of the AITFL are less likely to be involved in impingement during ankle dorsiflexion.
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11
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Zhang XY, Sun ZK, Wei WJ, Qiu ZL, Shen CT, Song HJ, Shi ZM, Luo QY. A Preliminary Study of Ankle Single Photon Emission Computed Tomography/Computed Tomography in Patients With Bony Impingement Syndrome: Association With the Visual Analogue Scale Pain Score. J Foot Ankle Surg 2019; 58:434-440. [PMID: 30876811 DOI: 10.1053/j.jfas.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Indexed: 02/03/2023]
Abstract
Both osteoarthritis and impingement syndrome are the disorders commonly observed in sports medicine. However, failure in pain alleviation by surgical intervention introduces challenges in the diagnosis and decision-making for orthopedists. Hybrid single photon emission computed tomography/computed tomography (SPECT/CT) provides both functional and structural information of ankle pathology. The purpose of this retrospective study was to evaluate whether bone tracer uptake by ankle SPECT/CT is related to the lesion type and visual analog scale (VAS) pain score for patients with osteoarthritis and bony impingement. Fifty individuals with chronic ankle pain who underwent pretreatment ankle SPECT/CT were included in the current study. The median follow-up period was 2.5 (range 1.8 to 3.2) years. The lesion types were categorized by the positions of anatomical changes and bone tracer uptake. The VAS pain score was recorded 2 weeks before and 1.5 year after surgical intervention. Twenty-nine (58%) of 50 patients had osseous impingement. Among them, 16 (55.2%), 4 (13.8%), and 9 (31%) patients had anterior, posterior, and both types of ankle impingement, respectively. The uptake grade of bone tracer was significantly related to the lesion type of ankle impingement (p < .001). The VAS pain score was significantly correlated with bone tracer uptake before treatment (p < .001). Bone tracer uptake was related to the lesion type of impingement detected by SPECT/CT and was confirmed by surgical findings. The VAS pain score was significantly correlated with the bone tracer uptake. Preoperative ankle SPECT/CT may be helpful to clinically correlate the VAS pain score in the pre- and postsurgical periods for patients with osteoarthritis and bony impingement syndrome.
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Affiliation(s)
- Xin-Yun Zhang
- Postgraduate Student, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Zhen-Kui Sun
- Radiologist, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Wei-Jun Wei
- Postgraduate Student, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Zhong-Ling Qiu
- Nuclear Medicine Attending, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Chen-Tian Shen
- Nuclear Medicine Resident, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Hong-Jun Song
- Nuclear Medicine Attending, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Zhong-Min Shi
- Professor, Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Quan-Yong Luo
- Professor, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
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12
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LiMarzi GM, Khan O, Shah Y, Yablon CM. Imaging Manifestations of Ankle Impingement Syndromes. Radiol Clin North Am 2018; 56:893-916. [DOI: 10.1016/j.rcl.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Accessory ossicles are supernumerary and inconstant structures that are not
caused by fractures. Derived from unfused ossification centers, accessory
ossicles were first described by Vesalius in 1543. For centuries, they were
believed to be asymptomatic. However, with advances in radiology techniques,
many have been associated with painful syndromes. Although the original
descriptions date from the sixteenth century, the subject is little discussed
and, in some cases, controversial. The objective of this study was to describe
the radiological aspects of a series of accessory ossicles and to review the
evolution of their various descriptions, in order to revive discussion of the
subject.
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Affiliation(s)
- André Vaz
- MD, Resident in Radiology and Diagnostic Imaging at the Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Cesar Rodrigo Trippia
- MD, Radiologist, Preceptor of the Radiology and Diagnostic Imaging Residency Program of the Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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14
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Al-Riyami AM, Tan HK, Peh WCG. Imaging of Ankle Impingement Syndromes. Can Assoc Radiol J 2017; 68:431-437. [PMID: 28865671 DOI: 10.1016/j.carj.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/14/2017] [Accepted: 04/08/2017] [Indexed: 01/17/2023] Open
Abstract
Ankle impingement syndromes are a commonly encountered clinical entity seen in athletes, secondary to repetitive forceful microtrauma. Symptoms are related to impingement of osseous or soft tissue abnormalities in the ankle joint, in particular the tibiotalar joint, which may result in painful limitation of ankle movements. Imaging modalities, such as radiographs and magnetic resonance imaging, are very useful in diagnosing osseous and soft tissue abnormalities seen in different types of ankle impingement syndromes. This article reviews the classification of ankle impingement syndromes, their etiology, and clinical and radiological findings.
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Affiliation(s)
| | - Hsien Khai Tan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Republic of Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Republic of Singapore.
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15
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Martins N, Seixas MI, Couto M, Monteiro P. Posterior Ankle Impingement Syndrome. REUMATOLOGIA CLINICA 2017; 14:244-245. [PMID: 28830674 DOI: 10.1016/j.reuma.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/30/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nádia Martins
- Rheumatology Department, Hospital de São Teotónio, Viseu, Portugal.
| | | | - Maura Couto
- Rheumatology Department, Hospital de São Teotónio, Viseu, Portugal
| | - Paulo Monteiro
- Rheumatology Department, Hospital de São Teotónio, Viseu, Portugal
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16
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Kumar J, Singh MS, Tandon S. Endoscopic management of posterior ankle impingement syndrome-A case report. J Clin Orthop Trauma 2017; 8:S21-S25. [PMID: 28878534 PMCID: PMC5574854 DOI: 10.1016/j.jcot.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/26/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022] Open
Abstract
Posterior ankle impingement syndrome (PAIS) is a clinical condition characterized by pain in the posterior aspect of ankle on performing activities requiring extreme plantar flexion. The impinging lesion could be bony and/or soft tissue. The operative treatment aims at removing the impinging lesion either by open or endoscopic surgery. The later has been shown to have benefits of early return to sports, better cosmesis, less wound complications. We report a case of a 19 year old footballer with PAIS secondary to Os Trigonum. The patient complained of pain on performing running and on kicking football. Conservative treatment in form of NSAIDS, rest, physiotherapy modality use could not ensure pain free return to sports.The patient was managed using endoscopic excision of the Os Trigonum followed by aggressive rehabilitation. The patient returned to competitive football at the end of 14 weeks after surgery. There were no wound complications. AAFOS score had changed from 73 to 100 and NPS scale showed pain score reduce from 7/10 to 1/10. We concluded that endoscopic management of PAIS to remove the impinging lesion is a minimally invasive technique that ensures early return to sports, good cosmesis, less risk of wound complications and good patient satisfaction.
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Affiliation(s)
- Jayant Kumar
- Department of Arthroscopy and Sports Medicine, Indian Spinal Injuries Center, New Delhi, India,Corresponding author at: SFS Flat 101/3, A block, Saket, New Delhi, India.
| | - Maninder S. Singh
- Department of Arthroscopy and Sports Medicine, Indian Spinal Injuries Center, New Delhi, India
| | - Suparna Tandon
- Department of Rehabilitation, Indian Spinal Injuries Center, New Delhi, India
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17
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Abstract
Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. It usually occurs following a sprain injury or repetitive microtrauma causing haemorrhage, synovial hyperplasia, and abnormal soft tissue interposition within the joint. MR imaging is particularly valuable in being able to detect not only the soft tissue and osseous abnormalities involved in these syndromes, but also a wide variety of other potential causes of ankle pain and instability that also may need to be addressed clinically.
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18
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Khan N, Sahota N, Shepel ML, Obaid H. Posterior ankle labral changes at MRI: A preliminary study. J Med Imaging Radiat Oncol 2017; 61:622-629. [PMID: 28419756 DOI: 10.1111/1754-9485.12609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The transverse ligament in the ankle joint has been described as a labrum-like structure in a previous cadaveric study. The purpose of this study is to assess the spectrum of abnormal changes related to this structure on imaging/MRI, and correlate these findings with other ankle joint findings and patient symptoms. METHOD A retrospective observational review of 172 ankle MRI scans was carried out independently by two fellowship trained musculoskeletal Radiologists. Correlation between abnormal labral changes, other ankle joint findings and patient symptomatology was performed. RESULTS Abnormal labral changes were seen in 26% of the MRI scans (n = 44/172) and included signal change, contour abnormality with heterogeneous signal change, linear fluid filled clefts, multidirectional fluid filled clefts, and a macerated labrum. There was a statistically significant association between abnormal labral changes and the presence of Stieda process/os trigonum (P = 0.001), talocrural joint osteoarthritis (P = 0.0003), paralabral cysts (P = 0.0001), imaging features of posterior impingement (P = 0.01), and both medial (P = 0.005) and lateral (P = 0.01) ankle ligament injuries. However, there was no statistically significant association between abnormal labral changes and patient symptoms. CONCLUSION The posterior ankle labrum can develop a spectrum of abnormal MRI appearances in patients with other ankle joint abnormalities. Although this study showed no correlation between patients' symptoms and posterior ankle labral changes, larger studies are needed to examine the biomechanical alterations that may arise from these labral changes.
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Affiliation(s)
- Nasir Khan
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Navdeep Sahota
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Michael L Shepel
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Haron Obaid
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada.,Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
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Meehan TM, Martinez-Salazar EL, Torriani M. Aftermath of Ankle Inversion Injuries. Magn Reson Imaging Clin N Am 2017; 25:45-61. [DOI: 10.1016/j.mric.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Maas M. Ankle. MUSCULOSKELETAL DISEASES 2017-2020 2017:25-31. [DOI: 10.1007/978-3-319-54018-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Berman Z, Tafur M, Ahmed SS, Huang BK, Chang EY. Ankle impingement syndromes: an imaging review. Br J Radiol 2016; 90:20160735. [PMID: 27885856 DOI: 10.1259/bjr.20160735] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ankle impingement syndromes encompass a broad spectrum of post-traumatic and chronic degenerative changes that present with pain on specific movements about the ankle joint. Both amateur and professional athletes are disproportionately affected by these conditions, and while conservative measures can potentially treat an impingement syndrome, definitive therapy is often alleviated surgically. Imaging (including conventional radiography, ultrasound, CT and MRI) plays an invaluable role in the diagnosis and pre-surgical work-up. An anatomically based classification system is useful in these syndromes, as the aetiology, sites of pathology and preferred treatment methods are similarly based on anatomic locations about the ankle. This review focuses on the anatomic locations, pathophysiology, imaging considerations and brief discussion of therapies for each of the major anatomic ankle impingement syndromes.
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Affiliation(s)
- Zachary Berman
- 1 Department of Radiology, University of California, San Diego, CA, USA
| | - Monica Tafur
- 2 Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonya S Ahmed
- 3 Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Brady K Huang
- 1 Department of Radiology, University of California, San Diego, CA, USA
| | - Eric Y Chang
- 1 Department of Radiology, University of California, San Diego, CA, USA.,4 Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Wong GNL, Tan TJ. MR imaging as a problem solving tool in posterior ankle pain: A review. Eur J Radiol 2016; 85:2238-2256. [PMID: 27842673 DOI: 10.1016/j.ejrad.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 12/12/2022]
Abstract
Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.
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Affiliation(s)
- Gloria N L Wong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
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Rosenbaum AJ, Positano RG, Positano RCJ, Dines JS. Ankle Impingement Caused by an Intra-articular Plica: A Report of 2 Cases. Foot Ankle Spec 2016; 9:79-82. [PMID: 25805439 DOI: 10.1177/1938640015578515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Entrapment of soft tissues in the anterolateral gutter of the ankle can cause impingement. When symptomatic, patients complain of chronic ankle pain exacerbated with dorsiflexion. Symptoms of instability and a history of recurring ankle sprains are common findings. Plain radiographs and magnetic resonance imaging may assist clinicians in identifying associated pathology. We present 2 cases of ankle impingement occurring in the setting of equivocal examination and imaging findings. In both cases, arthroscopy revealed a likely congenital, intra-articular plica. LEVELS OF EVIDENCE Therapeutic, Level IV: Case Study.
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Affiliation(s)
- Andrew J Rosenbaum
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Rock G Positano
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Rock C J Positano
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Joshua S Dines
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
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Battaglia PJ, Craig K, Kettner NW. Ultrasonography in the Assessment of Lateral Ankle Ligament Injury, Instability, and Anterior Ankle Impingement: A Diagnostic Case Report. J Chiropr Med 2015; 14:265-9. [PMID: 26793038 DOI: 10.1016/j.jcm.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/09/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the diagnostic value of ultrasonography (US) in a patient with injury to the lateral ligaments of the ankle with concomitant ankle joint osteoarthritis and anterior impingement. CLINICAL FEATURES A 28-year-old male had a history of an inversion injury of the left ankle. Diagnostic US of the left ankle using an 8- to 15-MHz linear array transducer demonstrated a full thickness tear of the anterior talofibular ligament, partial thickness tearing of the calcaneofibular ligament, and laxity of the ankle with varus stress testing. In addition, US was able to demonstrate degeneration of the ankle and talonavicular joints and anterior impingement with dorsiflexion. Osteoarthritic changes were confirmed with radiography. Other US findings included remote deltoid ligamentous complex injury, multiple sites of tenosynovitis, and a large ankle joint effusion with synovial hypertrophy and synovitis. INTERVENTION AND OUTCOME Using US, an accurate diagnosis was established with respect to the pathology and functional impairments of the patient's ankle. CONCLUSION This case report exemplifies the value and utility of US in diagnosing derangement in ligamentous, tendinous, articular, and osseous injuries of the ankle.
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Affiliation(s)
- Patrick J Battaglia
- Diagnostic Imaging Resident, Department of Radiology, Logan University, Chesterfield, MO
| | - Kate Craig
- Chiropractic Resident, Department of Pain Medicine, US Department of Veterans Affairs, Jefferson Barracks Division, St. Louis, MO
| | - Norman W Kettner
- Chair, Department of Radiology, Logan University, Chesterfield, MO
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Rehmani R, Endo Y, Bauman P, Hamilton W, Potter H, Adler R. Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions. HSS J 2015; 11:258-77. [PMID: 26788031 PMCID: PMC4712185 DOI: 10.1007/s11420-015-9442-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands. QUESTIONS/PURPOSES The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases. METHODS Online searches were performed using the search criteria of "ballet biomechanics" and "ballet injuries." The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals. RESULTS Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who "time is money". CONCLUSION Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
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Affiliation(s)
- Razia Rehmani
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yoshimi Endo
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Phillip Bauman
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - William Hamilton
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - Hollis Potter
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ronald Adler
- />Hospital for Joint Diseases, New York University, New York, NY USA
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Bech NH, de Leeuw PAJ, Haverkamp D. Posterior Ankle Impingement in Two Athletic Twin Brothers, Could Genetics Play a Role? J Foot Ankle Surg 2015. [PMID: 26215550 DOI: 10.1053/j.jfas.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pain posteriorly in the ankle can be caused by bony impingement of the posterolateral process of the talus. This process impinges between the tibia and calcaneus during deep forced plantar flexion. If this occurs it is called posterior ankle impingement syndrome. We report the case of 2 athletic monozygotic twin brothers with bony impingement posteriorly in the left ankle. Treatment consisted of ankle arthroscopy in both patients during which the symptomatic process was easily removed. At 3 months after surgery, both patients were completely free of pain, and 1 of the brothers had already returned to sports. The posterior ankle impingement syndrome is not a rare syndrome, but it has not been described in siblings thus far. That these 2 patients are monozygotic twin brothers suggests that genetics could play a role in the development of skeletal deformities that can result in posterior ankle impingement syndrome.
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Affiliation(s)
- Niels H Bech
- Orthopedic Surgery Resident, Slotervaart Hospital Amsterdam, Amsterdam, The Netherlands.
| | - Peter A J de Leeuw
- Orthopedic Surgery Resident, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Orthopedic Surgeon, Slotervaart Hospital Amsterdam, Amsterdam, The Netherlands
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27
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Hayashi D, Roemer FW, D'Hooghe P, Guermazi A. Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses. Eur J Radiol 2015; 84:2231-41. [PMID: 26239710 DOI: 10.1016/j.ejrad.2015.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/29/2015] [Accepted: 07/09/2015] [Indexed: 11/25/2022]
Abstract
Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers ('en pointe'), football players, javelin throwers and gymnasts. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. There are multiple causes of posterior ankle impingement. Most commonly, the structural correlates of impingement relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses.
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Affiliation(s)
- Daichi Hayashi
- ASPETAR - Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, Qatar; Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, United States; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610, United States
| | - Frank W Roemer
- ASPETAR - Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, Qatar; Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, United States; Department of Radiology, University of Erlangen Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany
| | - Pieter D'Hooghe
- ASPETAR - Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, Qatar
| | - Ali Guermazi
- ASPETAR - Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, Qatar; Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, United States.
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Kaelin R, Rieger B, Knupp M, Hirschmann MT. Traumatisiertes Os trigonum. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cha JG, Yi JS, Han JK, Lee YK. Comparison of Quantitative Cartilage T2 Measurements and Qualitative MR Imaging between Professional Ballet Dancers and Healthy Volunteers. Radiology 2015; 276:199-206. [PMID: 25759971 DOI: 10.1148/radiol.15142021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jang Gyu Cha
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Ji Sook Yi
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Jong Kyu Han
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Young Koo Lee
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
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Pesquer L, Guillo S, Meyer P, Hauger O. US in ankle impingement syndrome. J Ultrasound 2014; 17:89-97. [PMID: 24883131 DOI: 10.1007/s40477-013-0054-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/26/2022] Open
Abstract
Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Clinical symptoms are chronic pain located in the affected region and limited range of ankle motion. There are three types of ankle impingement syndrome: anterior impingement, which can be subdivided into anterolateral, anteromedial and purely anterior impingement; posterior impingement, which can be subdivided into posterior and posteromedial impingement; and calcaneal peroneal impingement which is secondary to planovalgus foot deformity. This paper evaluates physiological and clinical elements of these three types of ankle impingement syndrome as well as the role of ultrasound (US) imaging and US-guided treatment.
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Affiliation(s)
- Lionel Pesquer
- Centre d'imagerie ostéo-articulaire, Clinique du Sport, 2, Rue Georges Negrevergne, 33700 Mérignac, France
| | - Stephane Guillo
- Center for Orthopedic and Sports Surgery, Sports Clinic, Mérignac, France
| | - Philippe Meyer
- Centre d'imagerie ostéo-articulaire, Clinique du Sport, 2, Rue Georges Negrevergne, 33700 Mérignac, France
| | - Olivier Hauger
- Department of Diagnostic and Interventional Imaging, Hôpital Pellegrin, Bordeaux, France
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Abstract
Anterior ankle impingement is a common clinical condition characterized by chronic anterior ankle pain that is exacerbated on dorsiflexion. Additional symptoms include instability; limited ankle motion; and pain with squatting, sprinting, stair climbing, and hill climbing. Diagnosis is typically confirmed with plain radiographs. Nonsurgical management includes physical therapy, strengthening exercises, activity modification, bracing, and anti-inflammatory medication. Although arthroscopic treatment is sufficient in some patients, most require an open approach to address related pathology. We advocate aggressive range of motion as well as weight bearing postoperatively. Further study is needed to confirm current understanding of anterior ankle impingement and to better define treatment options and prevention strategies.
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Distraction-free ankle arthroscopy for anterolateral impingement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1019-23. [DOI: 10.1007/s00590-013-1357-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
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Somorjai N, Jong B, Draijer WF. Intra-articular plica causing ankle impingement in a young handball player: a case report. J Foot Ankle Surg 2013; 52:750-3. [PMID: 24160722 DOI: 10.1053/j.jfas.2013.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 02/03/2023]
Abstract
Ankle sprains are common injuries that respond well to rehabilitation. In the case of persisting symptoms, the differential diagnosis should include osteochondral defects, tendon injury, mechanical instability, and ankle impingement. In the present case report, we describe a 16-year-old male handball player who presented with persisting pain and locking in the right ankle 3 years after having sustained multiple minor inversion trauma. The clinical examination and conventional radiography showed no abnormalities. On magnetic resonance imaging, a flake fracture at the anteromedial talar dome and/or loose body was assumed. Arthroscopic examination revealed an intra-articular plica originating from an osteochondral fossa at the anteromedial tibial plafond. The plica was debrided. Retrospectively, the arthroscopic findings matched the radiographs and magnetic resonance images. The postoperative protocol consisted of early mobilization. At 6 weeks of follow-up, the patient had no pain and had returned to his sports activities. The present case report illustrates, to the best of our knowledge, the first case of ankle impingement due to a, most likely congenital, intra-articular plica arising from an osteochondral fossa at the anteromedial tibial plafond. This rare clinical condition can be diagnosed with magnetic resonance imaging. Arthroscopic debridement will effectively relieve the symptoms.
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Affiliation(s)
- Nicolaas Somorjai
- Orthopedic Resident, Department of Orthopedics, Orbis Medisch Centrum, Sittard-Geleen, The Netherlands.
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Russo A, Zappia M, Reginelli A, Carfora M, D'Agosto GF, La Porta M, Genovese EA, Fonio P. Ankle impingement: a review of multimodality imaging approach. Musculoskelet Surg 2013; 97 Suppl 2:S161-8. [PMID: 23949938 DOI: 10.1007/s12306-013-0286-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 12/01/2022]
Abstract
Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55-59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564-574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465-471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft-tissue impingement or in excluding other ankle pathology such as an osteochondral lesion of the talus. MR imaging can reveal evidence of previous ligamentous injury and also can demonstrate thickened synovium, fibrosis, or adjacent reactive soft-tissue edema. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes. In the majority of cases, ankle impingement is treated with conservative measures, with surgical debridement via arthroscopy or an open procedure reserved for patients who have refractory symptoms. In this article, we describe the clinical and potential imaging features, for the four main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, posterior, and posteromedial impingement.
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Affiliation(s)
- A Russo
- Department of Radiology, S. G. Moscati Hospital, Aversa, Italy.
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Spiga S, Vinci V, Tack S, Macarini L, Rossi M, Coppolino F, Boi C, Genovese EA. Diagnostic imaging of ankle impingement syndromes in athletes. Musculoskelet Surg 2013; 97 Suppl 2:S145-S153. [PMID: 23949936 DOI: 10.1007/s12306-013-0280-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
The chronic ankle pain is a very frequent clinical problem, which is often characterized by a painful mechanical limitation of full-range ankle movement. A large amount of causes are involved in its pathogenesis, but the most common forms are secondary to an osseous or soft tissue abnormality. Especially for professional athletes, impingement lesions are the most important causes of chronic pain; however, this symptomatology can also affect ordinary people, mostly in those who work in environments that cause severe mechanical stress on the joints. This group of pathologies is characterized by a joint conflict secondary to an abnormal contact among bone surfaces or between bones and soft tissues. Diagnosis is mainly clinic and secondly supported by imaging in order to localize the critical area of impingement and determine the organic cause responsible for the joint conflict. Treatments for different forms of impingement are similar. Usually, the first step is a conservative approach (rest, physiotherapy, ankle bracing, shoe modification and local injection of corticosteroids), and only in case of unsuccessful response, the second step is the operative treatment with open and arthroscopic techniques. The aim of the study is to describe different MR imaging patterns, comparing our data with those reported in the literature, in order to identify the best accurate diagnostic protocol.
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Affiliation(s)
- S Spiga
- Department of Radiology, University of Cagliari, Cagliari, Italy
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Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin 2013; 18:255-91. [PMID: 23707177 DOI: 10.1016/j.fcl.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.
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Affiliation(s)
- William John Ribbans
- The University of Northampton, School of Health, Park Campus, Northampton NN2 7AL, UK.
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Song AJ, Del Giudice M, Lazarus ML, Lomasney LM, Demos TC, Dux K. Radiologic case study. Os trigonum syndrome. Orthopedics 2013; 36:5, 63-8. [PMID: 23276329 DOI: 10.3928/01477447-20121217-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Albert J Song
- Department of Radiology, Loyola University Medical Center, Maywood, IL 60153, USA
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Li X, Shi L, Liu T, Wang L. Progress in the clinical imaging research of bone diseases on ankle and foot sesamoid bones and accessory ossicles. Intractable Rare Dis Res 2012; 1:122-8. [PMID: 25343083 PMCID: PMC4204596 DOI: 10.5582/irdr.v1.3.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 11/05/2022] Open
Abstract
Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However, these bone diseases are often misdiagnosed or mistreated. In patients with trauma history, relevant diseases of sesamoid bones and accessory ossicles as above mentioned are highly probable to be misdiagnosed as avulsion fractures. In such cases, radiographic findings may provide a basis for clinical diagnosis.
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Affiliation(s)
- Xiaozhong Li
- Department of Radiology, Affiliated Hospital of Gansu College of Traditional Chinese Medicine, Lanzhou, China
- Address correspondence to: Dr. Xiaozhong Li, Department of Radiology, Affiliated Hospital of Gansu College of Traditional Chinese Medicine, No.732 Jiayuguan West Road, Lanzhou 730020, China. E-mail:
| | - Lenian Shi
- Department of Radiology, Affiliated Hospital of Gansu College of Traditional Chinese Medicine, Lanzhou, China
| | - Taiyun Liu
- Department of Radiology, Affiliated Hospital of Gansu College of Traditional Chinese Medicine, Lanzhou, China
| | - Lin Wang
- Department of Radiology, Affiliated Hospital of Gansu College of Traditional Chinese Medicine, Lanzhou, China
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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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Jacobson K, Ng A, Haffner KE. Arthroscopic treatment of anterior ankle impingement. Clin Podiatr Med Surg 2011; 28:491-510. [PMID: 21777781 DOI: 10.1016/j.cpm.2011.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable.
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Affiliation(s)
- Keith Jacobson
- Private Practice, Advanced Orthopedic and Sports Medicine Specialist, Denver, CO 80230, USA.
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Stieda process versus Haglund’s deformity: An uncommon presentation of posterior ankle impingement. Open Med (Wars) 2011. [DOI: 10.2478/s11536-011-0001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractPosterior ankle impingement syndrome represents an important cause of chronic ankle pain and has been extensively described in the orthopaedic and radiology literature. A rare case of this painful hindfoot disorder that resulted from two concurrent developmental anomalies is presented herein.
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Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol 2011; 18:211-25. [DOI: 10.1007/s10140-011-0945-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/21/2011] [Indexed: 12/26/2022]
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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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Ferkel RD, Tyorkin M, Applegate GR, Heinen GT. MRI evaluation of anterolateral soft tissue impingement of the ankle. Foot Ankle Int 2010; 31:655-61. [PMID: 20727312 DOI: 10.3113/fai.2010.0655] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The usefulness of magnetic resonance imaging (MRI) has been questioned in evaluating patients with chronic ankle sprain pain. The purpose of this study was to determine the effectiveness and reliability of routine MR imaging in the diagnosis of anterolateral soft tissue impingement. MATERIALS AND METHODS Inclusion criteria required that the MR examinations be performed by the same musculoskeletal radiologist after the most recent scanner upgrade and using a dedicated ankle/hindfoot coil. The surgical and MRI reports of 24 patients who had an arthroscopic diagnosis of anterolateral soft tissue impingement of the ankle were tabulated and categorized. Unlike previous studies, sagittal T1 and Short Tau Inversion Recovery (STIR) images were used primarily in the diagnosis of these lesions. RESULTS Using this technique, we report a 78.9% accuracy in diagnosis, a sensitivity of 83.3% and a specificity of 78.6%. Fifty-eight percent of patients had an associated diagnosis, which in 33% of patients altered our surgical plan. CONCLUSION Although not indicated in all cases of anterolateral ankle impingement, we advocate the use of MR imaging in complicated clinical presentations where the exclusion of additional pathology in the ankle or subtalar joint, and the confirmation of anterolateral soft tissue impingement would be beneficial.
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Affiliation(s)
- Richard D Ferkel
- Southern CA Ortho Institute, Orthopaedic Surgery, Van Nuys, CA 91405, USA.
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Abstract
Soft-tissue ankle injuries are extremely common and frequently present in the emergency department or to the general practitioner. The lateral ligament complex is most commonly affected, usually following an injury with the ankle in an inverted, plantar-flexed position. The diagnosis is usually clinical, and delayed examination and reassessment 3—5 days after injury is recommended as pain and swelling hinder accurate assessment immediately following injury. Applying the Ottawa ankle rules can reduce the number of unnecessary radiographs. Treatment is usually non-operative with the focus on controlling ankle swelling and pain, and early restoration of ankle movements. Surgical repair of ligaments may be indicated in certain cases, though the role of surgery in the acute setting remains unclear. In the present review, we discuss the anatomy, mechanism of injury, risk factors, clinical presentation, diagnosis, treatment and outcome of soft-tissue ankle injuries as well as consider how such injuries may be prevented.
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Affiliation(s)
- GS Matharu
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK,
| | - PS Najran
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
| | - KM Porter
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
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Lima CMADO, Ribeiro EB, Coutinho EPD, Vianna EM, Domingues RC, Coutinho Júnior AC. Síndrome do impacto do tornozelo na ressonância magnética: ensaio iconográfico. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000100013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A síndrome do impacto do tornozelo é uma condição dolorosa causada por atrito de tecidos articulares, que é tanto causa quanto consequência de uma biomecânica alterada desta articulação. A sua principal causa são as lesões pós-traumáticas, principalmente lesões ligamentares, resultando em dor crônica no tornozelo. Do ponto de vista anatômico e clínico, estas síndromes são classificadas em: ântero-lateral, anterior, ântero-medial, póstero-medial e posterior. A ressonância magnética é um ótimo método diagnóstico para demonstrar as alterações ósseas e as partes moles dos vários tipos de impacto do tornozelo, fornecendo dados que auxiliam não só na comprovação desse diagnóstico, como na diferenciação com outras causas de dor articular. Os autores objetivam ilustrar os principais achados de ressonância magnética na síndrome do impacto do tornozelo.
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Affiliation(s)
| | | | - Elisa Pompeu Dias Coutinho
- Centro de Diagnóstico por Imagem Fátima Digittal, Brasil; Clínicas de Diagnóstico Por Imagem (CDPI)/Multi-Imagem
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Abstract
Ankle impingement and instability are well-recognized complications of ankle sprain. Ankle impingement is an important cause of chronic ankle pain in active populations, particularly in the professional athlete. Depending on anatomical location and the structures involved, impingement syndromes are classified into anterolateral, anterior, posterior, posteromedial, and anteromedial types. Clinically, impingement syndromes are characterized by painful limitation of full-ankle movement. Ankle impingement results from repetitive subclinical trauma due to overuse injuries, which, in the subacute or chronic situation, lead to abnormal osseous and soft-tissue thickening within the ankle joint. Various imaging techniques can be used in the diagnosis of ankle impingement. Usually, radiography is the initial imaging technique performed to rule out bony trauma and identify potential anatomical bony abnormalities. Use of computed tomography and isotope bone scanning is largely superseded by magnetic resonance imaging, although with variable sensitivity and specificity. Arthrographic techniques, using computed tomography or magnetic resonance, are useful for exquisite demonstration of capsular recesses and synovial abnormalities. Imaging-guided injection techniques can be used in the management of impingement for pain ablation and to aid clinical diagnosis, especially in hind foot pain.
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Affiliation(s)
- Abhijit Datir
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, London, UK
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