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Mendicino R, Bischoff A, Hill Z. The Aggressive Open Anterior Ankle Cheilectomy as Joint Salvage for Anterior Ankle Impingement Syndrome and Arthritis. Foot Ankle Spec 2024; 17:57S-62S. [PMID: 36631944 DOI: 10.1177/19386400221148538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Anterior ankle impingement syndrome can frequently present in athletes and post-traumatic patients who have osteophytes contributing to limited dorsiflexion and pain. Surgical treatment options include arthroscopy, open arthrotomy, arthrodesis, and total implant arthroplasty. For many, joint-sparing arthroscopy or arthrotomy yield satisfactory results if significant debridement is performed. If debridement is not aggressive, patients may not obtain the desired improvement. In cases where a larger amount of bone must be removed, or the patient does not have an anatomic appearing talar neck due to osteophytic changes, we have found that an open approach is necessary to achieve good results. To the best of our knowledge, no such technique has been previously published detailing a standard approach to open ankle arthrotomy. Our technique is coined the "Aggressive Open Anterior Ankle Cheilectomy" and involves a systematic 3-step approach. First, the tibial osteophytes are resected with an osteotome; second, the ankle gutters are addressed, and all hypertrophic bones removed; and third, an anatomic talar neck is fashioned. We herein describe our surgical technique and case examples.Level of Evidence: 5.
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Affiliation(s)
- Robert Mendicino
- Medical Education Department, OhioHealth Grant Medical Center, Columbus, Ohio
| | - Alex Bischoff
- Medical Education Department, OhioHealth Grant Medical Center, Columbus, Ohio
| | - Zachary Hill
- Medical Education Department, OhioHealth Grant Medical Center, Columbus, Ohio
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Sugimoto K, Isomoto S, Matsui T, Tanaka K, Matsuyama K, Taniguchi A, Tanaka Y. Anterior Ankle Impingement Syndrome With Spur Fragmentation: Is It an Os Talotibiale? FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231224724. [PMID: 38288289 PMCID: PMC10823857 DOI: 10.1177/24730114231224724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Background Bone fragments are often found in ankles with anterior bony impingement. However, whether they are detached osteophytes or accessory bones remains unknown. Methods Among the 66 continuously enrolled cases of ankles with anterior bony impingement, 32 had a fragment located at the anterior margin of the tibia. The cases of posterior impingement, lateral instability, osteochondral lesions, or free bodies simultaneously treated were excluded. The enrolled subjects were classified into 2 groups: ankles without (group A) and with remarkable spurs (group B). The patients' backgrounds, location of the fragments, clinical scores, and other parameters required to resume sports were compared. The Japanese Society for Surgery of the Foot (JSSF) ankle rating scale was used to evaluate preoperative and postoperative ankle conditions, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) was used to evaluate postoperative sports abilities. Results Eight (seven subjects) and 11 ankles were classified into groups A and B, respectively, and the mean age of the 18 patients was 25.4 (range, 16-37) years. No statistical differences in patient backgrounds or fragment sizes between the groups existed. In group A, the fragments were located on the lateral plateau in 7 of the 8 ankles, whereas in group B, their locations varied. The patients were followed up for a median of 48 months (range, 24-168). No complications were observed. The postoperative JSSF and SAFE-Q sports activity scores were significantly higher in group A than in group B (P <.01 and <.001, respectively). The postoperative term to return to their original sports activities was significantly shorter in group A (P < .05). Conclusion Anterior bony fragments of the ankle without a remarkable spur were located at a specific site, and the results of arthroscopic treatment were better than in those with remarkable spurs. Such a fragment may be called an os talotibiale. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Kazuya Sugimoto
- Nara Prefecture General Medical Center, Nara-shi, Nara, Japan
| | - Shinji Isomoto
- Nara Prefecture General Medical Center, Nara-shi, Nara, Japan
| | | | - Kazunori Tanaka
- Nara Medical University, School of Medicine, Kashihara-shi, Nara, Japan
| | - Kou Matsuyama
- Nara Prefecture General Medical Center, Nara-shi, Nara, Japan
| | - Akira Taniguchi
- Nara Medical University, School of Medicine, Kashihara-shi, Nara, Japan
| | - Yasuhito Tanaka
- Nara Medical University, School of Medicine, Kashihara-shi, Nara, Japan
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3
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Yan Y, Lu H, Zhang J, Yu X, Liu Y, Chen G, Xu H, Xu R. Talar coverage of the tibia plays a role in anterior ankle impingement: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2693-2698. [PMID: 37479892 DOI: 10.1007/s00264-023-05898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Ankle impingement is generally characterised by limited range of motion and pain due to pathological contact between structures. Anterior ankle impingement is usually diagnosed by clinical examination and radiographic evidence of tibiotalar osteophytes. In addition to osteophytes, radiographs may show a correlation between the tibia and talus, which may further aid in the diagnosis of anterior ankle impingement. The purpose of this study is to investigate the relationship between the tibia and talus in anterior ankle impingement. METHODS In this retrospective cohort study, the tibial coverage of 22 patients with anterior ankle impingement was compared with that of 67 healthy subjects. RESULTS The percentage of tibial coverage was 0.674 ± 0.043 in the anterior ankle impingement group and 0.580 ± 0.032 in the control group. The difference between groups was statistically significant (P < 0.05). CONCLUSIONS In addition to existing criteria, the percentage of tibial coverage may provide valuable information for the diagnosis of anterior ankle impingement.
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Affiliation(s)
- Yongqing Yan
- Department of Orthopedics, HwaMei Hospital, University of Chinese Academy of Science, Province, Ningbo City Zhejiang, 315010, China
| | - Hao Lu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Jingyu Zhang
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Xiao Yu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Yubo Liu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Guangxiang Chen
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Hailin Xu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Renjie Xu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China.
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Dujela MD, Houng BE. Arthroscopic Treatment of Anterior Ankle Impingement. Clin Podiatr Med Surg 2023; 40:397-411. [PMID: 37236678 DOI: 10.1016/j.cpm.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Arthroscopic reduction of tibiotalar osteophytes results in good to excellent results in the vast majority of patients. Pain is primarily due to synovial hypertrophy and anterior tibiotalar entrapment associated with the osteophytes. Osteophytes may be due to repetitive trauma such as sports, or associated with subtle or overt ankle instability. A minimally invasive approach results in rapid recovery and less risk than open interventions. In cases where anterior osteophytes have coexisting ankle instability and in many cases ancillary procedures such as ankle stabilization are performed.
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Affiliation(s)
- Michael D Dujela
- Advanced Reconstructive Foot and Ankle Surgery, Washington Orthopaedic Center, 1900 Cooks Hill Road, Centralia, WA 98532, USA.
| | - Brian E Houng
- Advanced Reconstructive Foot and Ankle Surgery, Washington Orthopaedic Center, 1900 Cooks Hill Road, Centralia, WA 98532, USA
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Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-Office Needle Arthroscopy for the Treatment of Anterior Ankle Impingement Yields High Patient Satisfaction With High Rates of Return to Work and Sport. Arthroscopy 2022; 38:1302-1311. [PMID: 34571184 DOI: 10.1016/j.arthro.2021.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of in-office needle arthroscopy (IONA) for the treatment of anterior ankle impingement in the office setting and also evaluate patient experience of the IONA procedure. METHODS A prospectively collected database of 31 patients undergoing IONA for the treatment of anterior ankle impingement between January 2019 and January 2021 was retrospectively reviewed. Inclusion criteria for this study were patients ≥18 years of age, clinical history, physical examination, radiographic imaging, and magnetic resonance imaging findings consistent with anterior ankle impingement for which each patient underwent IONA and had a minimum of 12-month follow-up. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: the Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A 5-point Likert scale regarding patient satisfaction with their IONA procedure was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. RESULTS In total, 31 patients were included in this study, including 18 male and 13 female, with a mean age of 41.7 ± 15.5 years (range, 17-69 years) and mean body mass index of 27.3 ± 5.7 (range, 19.37-41.5). The mean follow-up time was 15.5 ± 4.9 months. The mean postoperative FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life were 79.4 ± 11.9, 82.9 ± 15.3, 83.5 ± 15.4, 71.9 ± 18.5 and 64.3 ± 21.4 at final follow-up respectively. Minimal clinically important difference was achieved by 84% of patients for FAOS pain, 77% for FAOS symptoms, 75% for FAOS Quality of Life, 74% for FAOS sports, 65% for PROMIS Pain Interference, 61% for FAOS Activities of Daily Living, and 42% for PROMIS Pain Intensity. Lastly, 29 patients (94 %) expressed willingness to undergo the same procedure again. CONCLUSIONS The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate and excellent patient reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again. LEVEL OF EVIDENCE IV, Case series study.
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Affiliation(s)
| | | | - Jeremie V Garcia
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY.
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Fischer S, Weber S, Gramlich Y, Blank M, Buckup J, Manegold S, Hoffmann R. Electrothermal Denervation of Synovial and Capsular Tissue Does not Improve Postoperative Pain in Arthroscopic Debridement of Anterior Ankle Impingement—A Prospective Randomized Study. Arthrosc Sports Med Rehabil 2022; 4:e575-e583. [PMID: 35494284 PMCID: PMC9042778 DOI: 10.1016/j.asmr.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/13/2021] [Indexed: 10/25/2022] Open
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O'Brien MC, Dzieza WK, Bruner ML, Farmer KW. Sufficient Cartilage for Most Talar Articular Defects Can Be Harvested From the Non-Loadbearing Talus: A Cadaveric Analysis. Arthrosc Sports Med Rehabil 2021; 3:e1315-e1320. [PMID: 34712969 PMCID: PMC8527272 DOI: 10.1016/j.asmr.2021.05.012] [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: 11/01/2020] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the quantity of morselized cartilage that can be harvested from the non–load-bearing portion of the talus for immediate reimplantation. Methods Non–load-bearing talar cartilage was harvested from 5 cadaveric specimens using a standard arthroscopic approach. Cartilage was separated from the talus in maximum dorsiflexion at the junction of the talar head and neck, grasped, and morselized into a graft using a cartilage particulator. The volume of reclaimed cartilage was measured, and the extrapolated area of coverage was compared to average osteochondral lesions of the talus previously reported. Results The total yield of cartilage graft following processing that was obtained from 5 ankle joints ranged from 0.3 mL to 2.1 mL with a mean volume of 1.3 ± 0.7 mL, yielding a theoretical 13.2 ± 7.1 cm2 coverage with a 1-mm monolayer. While the average size of osteochondral lesions of the talus is difficult to estimate, they may range from 0.5 cm2 to 3.7 cm2 according to the literature. Conclusions This study validated that it is possible to harvest sufficient amount of cartilage for an autologous morselized cartilage graft via a single-stage, single-site surgical and processing technique to address most talar articular cartilage defects. Clinical Relevance Particulated cartilage autografts have shown promise in surgical management of cartilage defects. A single-site, single-staged procedure that uses a patient’s autologous talar cartilage from the same joint has the potential to reduce morbidity associated with multiple surgical sites, multistaged procedure, or nonautologous tissue in ankle surgery.
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Affiliation(s)
- Michael C O'Brien
- University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Wojciech K Dzieza
- University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Michelle L Bruner
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, U.S.A
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Gianakos AL, Ivander A, DiGiovanni CW, Kennedy JG. Outcomes After Arthroscopic Surgery for Anterior Impingement in the Ankle Joint in the General and Athletic Populations: Does Sex Play a Role? Am J Sports Med 2021; 49:2834-2842. [PMID: 33400547 DOI: 10.1177/0363546520980096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although anterior ankle impingement is a common pathology within the athletic population, there have been limited data evaluating outcomes of arthroscopic intervention and whether patient sex affects treatment outcomes. PURPOSE To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if patient sex affects outcomes. STUDY DESIGN Systematic review. METHODS A systematic literature search of the MEDLINE, Embase, and Cochrane databases was performed during August 2019. The following combination of search terms was utilized: "ankle," "impingement," "talus," "osteophyte," "arthroscopy," "surgery," "procedures," and "treatment." Two reviewers independently performed data extraction. RESULTS A total of 28 articles evaluating 1506 patients were included in this systematic review. Among the studies, 60% (17/28) and 14% (4/28) assessed anterolateral and anteromedial impingement, respectively. Good to excellent results were reported after arthroscopy in patients with anterior ankle impingement, with a success rate of 81.04%. All studies that evaluated functional outcomes (16/16; 100%) cited improvements in American Orthopaedic Foot & Ankle Society scale, visual analog scale, and Foot Function Index. The average complication rate was 4.01%, with the most common complications being mild nerve symptoms and superficial infection. The most common concomitant pathologies included synovitis, osteophytes, meniscoid lesions, and anterior inferior tibiofibular ligament injury. Four studies (15%) failed to report sex as a demographic variable. Only 7 (25%) studies included analysis by sex, with 4 (57%) of these demonstrating differences when comparing outcomes by patient sex. When compared with male patients, female patients exhibited higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement. CONCLUSION Our systematic review demonstrates that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes, low complication rates, and good return-to-sports rates in both the general and the athletic population. This study also reports a lack of statistical analysis evaluating outcomes comparing male and female populations. The included studies demonstrate that, compared with male patients, female patients have higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement; therefore, particular attention should be paid to addressing such concomitant pathology.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Axel Ivander
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Christopher W DiGiovanni
- Foot and Ankle Service, Department of Orthopaedic Surgery, Harvard-Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Abstract
Ankle impingement presents with painful and limited range of motion with dorsiflexion or plantar flexion, originating from pathological contact between bone and/or soft-tissue structures. Diagnosis is made primarily through clinical examination with adjunct radiographs and magnetic resonance imaging, with care taken to rule out a plethora of similarly presenting pathologies. Arthroscopic surgical approaches bring satisfactory short, mid, and long-term outcomes, with the current body of evidence dominated by Level-IV studies. Minimally invasive techniques offer improvements in time to return to play and complication rates relative to open approaches. Recent advances in the arthroscopic management of ankle impingement include long-term outcome studies, novel prognostic classification systems, and strategies for concomitant lesion management.
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Abstract
INTRODUCTION Ankle arthroscopy has come a long way since it was thought, it is not feasible because of tight joint and anatomical characteristics of ankle joint. The same anatomical features like capsular attachment and safe accessory portals are used to access the whole joint even with a rigid arthroscope. Ankle distraction method was routinely used to access the anterior ankle. However, nowadays, anterior arthroscopy is done in dorsiflexion as this increases the anterior ankle joint volume, and thereby easy access to various anatomical structures. On the other hand, intermittent traction is used to access the posterior ankle. Initially used as a diagnostic tool, ankle arthroscopy is now used extensively as a therapeutic and reconstruction tool. New evidence is published for all inside ligament reconstructions, effective management of impingement syndromes, and osteochondral lesions. The indications are being extended to fracture management and arthrodesis. METHODOLOGY This narrative review was performed following a literature search in the Pubmed database and Medline using the following keywords: ankle arthroscopy, portals, ankle OCD, functional outcome. Related articles were then reviewed. CONCLUSION Complications rate is reduced with a better understanding of the relative anatomy of surrounding neurovascular structures and tendons with regard to the position of ankle joint. This review on ankle arthroscopy focuses on anatomy, indications, and complications. Ankle arthroscopy is a safe and elegant tool as any other joint arthroscopy.
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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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Debridement and hinged motion distraction is superior to debridement alone in patients with ankle osteoarthritis: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:2802-2812. [PMID: 30264242 DOI: 10.1007/s00167-018-5156-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate and compare complication rates and postoperative outcomes in patients with ankle debridement alone vs. debridement and hinged ankle distraction arthroplasty. METHODS A total of 50 patients with posttraumatic ankle osteoarthritis (OA) with a mean age of 40.0 ± 8.5 years were included into this prospective randomized study: 25 patients in ankle debridement alone group and 25 patients in debridement and hinged ankle distraction group. The mean follow-up was 46 ± 12 months (range 36-78 months). The clinical and radiographic outcomes were evaluated at the 6-month and 3-year follow-up using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, SF-36 quality of life score, and van Dijk OA classification. A Kaplan-Meier survival analysis was performed to calculate the 3-year and 5-year survival rates. RESULTS Both patient groups experienced significant pain relief, functional improvement, and improvement in quality of life postoperatively. In total, 26 major secondary procedures were performed. The overall survival rates in the debridement and ankle distraction group were 19 of 25 (74%) and 15 of 25 (59%) at 3 years and 5 years, respectively. The overall survival rates in the ankle debridement alone group were 12 of 25 (49%) and 9 of 25 (34%) at 3 years and 5 years, respectively. CONCLUSIONS The study demonstrated comparable postoperative functional outcome and quality of life. However, rate of postoperative revision surgery was substantially higher in ankle debridement alone group. LEVEL OF EVIDENCE Randomized controlled study, Level I.
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Chen L, Wang X, Huang J, Zhang C, Wang C, Geng X, Ma X. Outcome Comparison Between Functional Ankle Instability Cases With and Without Anterior Ankle Impingement: A Retrospective Cohort Study. J Foot Ankle Surg 2019; 58:52-56. [PMID: 30583782 DOI: 10.1053/j.jfas.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 02/03/2023]
Abstract
Functional ankle instability (FAI) and anterior ankle impingement (AAI) are likely to occur simultaneously. Nevertheless, how AAI affects ankle instability remains largely unknown. This study aimed to assess patients with FAI + AAI and those having FAI without AAI after arthroscopic synovectomy combined with the modified Broström procedure. Patients with chronic ankle instability who underwent surgery at the Huashan Hospital of Fudan University (China) from January 2010 to December 2015 were reviewed. Propensity score matching was performed (FAI + AAI: n = 86; FAI without AAI: n = 43). Ankle function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) and the Meislin criteria at 3 months, 1 year, and final follow-up. In the FAI + AAI group, AOFAS scores increased from 52.6 ± 7.2 to 78.6 ± 8.2, 84.2 ± 6.4, and 83.6 ± 11.3 at 3 months, 1 year, and last follow-up, respectively (p < .001). In the FAI without AAI group, AOFAS scores increased from 64.3 ± 10.5 to 85.2 ± 8.6, 91.4 ± 7.9, and 90.2 ± 9.8 at 3 months, 1 year, and last follow-up, respectively (p < .001; all p < .05 for differences between the 2 groups at each time point). The 2 groups showed similar scores based on the Meislin criteria (p = .38). Hypertrophic distal fascicle of the anteroinferior tibiofibular ligament showed lower AOFAS scores (all p < .05). Patients with FAI with or without AAI had improved outcomes with arthroscopic synovectomy combined with the modified Broström procedure; however, patients with combined FAI and AAI showed a relatively poorer outcome in comparison with those suffering from FAI alone, probably because of hypertrophic distal fascicle of the anteroinferior tibiofibular ligament.
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Affiliation(s)
- Li Chen
- Surgeon, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Xu Wang
- Professor, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Jiazhang Huang
- Professor, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Chao Zhang
- Surgeon, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Chen Wang
- Surgeon, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Xiang Geng
- Surgeon, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Xin Ma
- Professor, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China.
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Yang Q, Zhou Y, Xu Y. Arthroscopic debridement of anterior ankle impingement in patients with chronic lateral ankle instability. BMC Musculoskelet Disord 2018; 19:239. [PMID: 30025527 PMCID: PMC6053762 DOI: 10.1186/s12891-018-2168-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the functional and radiological outcomes of arthroscopic treatment of anterior ankle impingement (AAI) in patients with chronic lateral ankle instability (CAI). METHODS All patients with CAI between June 2012 and May 2015 were invited to participate in this investigation. All of them accepted open modified Broström repair of lateral ankle ligaments and were divided into two groups: AAI group (with anterior ankle impingement) and pure CAI group (without anterior ankle impingement). All of them were followed up using American Orthopaedic Foot and Ankle Society Score (AOFAS), Karlsson Ankle Functional Score and Tegner activity score. Ankle dorsiflexion was also examined. X-ray examination was applied to investigate anterior tibiotalar osteophytes. RESULTS Finally, a total of 60 patients were followed up at a mean of 37 ± 10 months, including 22 patients in the AAI group and 38 patients in the pure CAI group. Preoperatively, the AAI group had significant lower AOFAS score (62.9 ± 11.7 vs 72.9 ± 11.1; p = 0.002) and Tegner activity score (1.5 ± 0.8 vs 2.1 ± 1.0; p = 0.04) respectively when compared with the pure CAI group. The ankle dorsiflexion of the AAI group (13 ± 2.1) was also significantly lower than that of the pure CAI group (26.2 ± 2.1) (p = 0.001). However, there was no significant difference in the AOFAS score or the Karlsson score or the Tegner score or the Ankle dorsiflexion between the two groups postoperatively. The postoperative X-ray images demonstrated complete osteophyte resection in all patients, and no recurrence of osteophyte. CONCLUSION The functional outcome scores and dorsiflexion had significantly improved postoperatively. Combined treatment of chronic ankle instability and anterior ankle impingement produced satisfactory surgical outcomes in patients with CAI accompanied by anterior ankle impingement symptom.
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Affiliation(s)
- Qining Yang
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, 215004, Jiangsu, China.,Department of joint orthopaedic surgery, Jinhua hospital of Zhejiang University (Jinhua municipal central hospital), Jinhua, Zhejiang, 321000, People's Republic of China
| | - Yongwei Zhou
- Department of joint orthopaedic surgery, Jinhua hospital of Zhejiang University (Jinhua municipal central hospital), Jinhua, Zhejiang, 321000, People's Republic of China
| | - Youjia Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, 215004, Jiangsu, China. .,Department of Orthopedics, 2nd Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, Jiangsu, 215000, People's Republic of China.
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Mallow M, Gwin S. The Trouble Ankle: Persistent Pain After Inversion Ankle Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0185-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Abstract
Ankle arthritis can be broadly classified as primary arthritis (nontraumatic degeneration) or secondary arthritis (post-traumatic degeneration). A good understanding of the anatomic features and presentations associated with each will assist the surgeon in determining the best course of action for each patient. Many variations of both primary and secondary arthritis can be treated conservatively; however, there are many times when conservative therapy is not adequate. In these cases, ankle arthroscopy may be considered before a joint fusion or replacement. Here, the authors discuss the common types of ankle arthritis, their presentations, and treatment success with ankle arthroscopy.
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Affiliation(s)
- Eric A Barp
- Podiatry, The Iowa Clinic, 5950 University Avenue, West Des Moines, IA 50266, USA.
| | - John G Erickson
- Podiatry, Boone County Hospital, 1015 Union Street, Boone, IA 50036, USA
| | - Jennifer L Hall
- Podiatric Residency, UnityPoint Health-Des Moines, 1415 Woodland Avenue, Suite 100, Des Moines, IA 50309, USA
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17
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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: 34] [Impact Index Per Article: 4.9] [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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18
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Abstract
An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.
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Affiliation(s)
- Siu Him Janus Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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19
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Das steife Sprunggelenk. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Walker R, Kunkle WA, Carreira DS. Arthroscopic Approach to Osteochondral Defects, Impingement, and Instability. Clin Sports Med 2015; 34:689-703. [PMID: 26409590 DOI: 10.1016/j.csm.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteochondral defects, impingement, and instability of the ankle are common injuries in athletes. In this article, we review these diagnoses and their treatment options, with a focus on arthroscopic approaches. The treatment options continue to evolve, supported by innovation and outcome studies. In this article, we describe the advantages and disadvantages of both open and arthroscopic treatments using published evidence.
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Affiliation(s)
- Roger Walker
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA
| | - William Aaron Kunkle
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA
| | - Dominic S Carreira
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA.
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