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Osanami H, Akuzawa H, Sakamoto K, Yokota H, Hirabayashi R, Sekine C, Ishigaki T, Edama M. Validation of anterior ankle soft tissue dynamics and shear modulus for anterior ankle impingement syndrome after ankle fracture surgery. Sci Rep 2024; 14:5863. [PMID: 38467787 PMCID: PMC10928075 DOI: 10.1038/s41598-024-56671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Anterior ankle impingement syndrome (AAIS) has been reported to account for a high percentage of complications following ankle fracture surgery. The soft tissue etiology of AAIS is thought to be thickening and inflammation of the anterior ankle soft tissues intervening anteriorly at the tibiotalar joint, causing pain and functional limitation during dorsiflexion. However, the effects of anterior ankle soft tissue dynamics and stiffness on AAIS have yet to be clarified. This study aimed to determine the relationship between AAIS and the anterior ankle soft tissue thickness change ratio and shear modulus using ultrasonography (US). The participants were 20 patients with ankle joint fractures (AO classification A, B) who had undergone open reduction and internal fixation and 20 healthy adults. The evaluation periods were 3 months and 6 months postoperatively. US was used to delineate the tibialis anterior tendon, extensor hallucis longus tendon, and the extensor digitorum longus tendon over the talus and tibia on a long-axis image. Anterior ankle soft tissue thickness was measured as the shortest distance from the most convex part of the talus to the tendon directly above it. The Anterior ankle soft tissue thickness change ratio was determined by dividing the value at 0° dorsiflexion by the value at 10° plantarflexion. The same images as for the anterior soft tissue thickness measurement were drawn for the shear modulus measurement, and the average shear modulus (kPa) was calculated using shear-wave elastography. There was no significant difference in the thickness change ratio between the postoperative and healthy groups. Compared with the healthy group, the shear modulus was significantly higher at 3 and 6 months in the postoperative group (p < 0.01). The shear elastic modulus at 6-month postoperative group was significantly lower than at 3-month postoperative group (p < 0.01). Anterior ankle joint soft tissue stiffness may increase after surgery for an ankle fracture.
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Affiliation(s)
- Haruki Osanami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
- Department of Rehabilitation, Keiyu Orthopaedic Hospital, 2267 Akoda, Tatebayashi, Gunma, 374-0013, Japan
| | - Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Kodai Sakamoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan.
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Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability. Arch Orthop Trauma Surg 2024; 144:815-822. [PMID: 37982838 DOI: 10.1007/s00402-023-05123-2] [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] [Received: 07/10/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Repeated ankle sprains can lead to chronic lateral ankle instability (CLAI). It is unclear whether CLAI causes pain unless complicated by intra-articular lesions. This study aimed to analyze the characteristics of pain and the relationship between pain and intra-articular pathology in patients with CLAI. MATERIALS AND METHODS Fifty-three ankles in 46 patients with CLAI who had undergone surgery were retrospectively reviewed. The self-administered foot evaluation questionnaire (SAFE-Q) was given to patients the day before surgery. Intra-articular lesions were assessed using arthroscopy and magnetic resonance imaging (MRI). In addition, the Hounsfield Unit (HU) on computed tomography (CT) of the medial gutter was measured. The relationship between pain and intra-articular findings was also analyzed. RESULTS The pain and pain-related scores in the SAFE-Q were significantly correlated with synovitis in 96.3% (rs = - 0.532). HU ratios in the tibia and talus were also significantly correlated with pain (rs = - 0.603, - 0.534, respectively). The arthroscopic synovitis score and HU ratios in patients with high pain scores were significantly higher than those in patients with low pain scores. Forty ankles (75.5%) had synovitis and articular cartilage injuries were observed in 22 ankles (41.5%). Patients with fluid collection or bone marrow lesions (BML) scored significantly lower in pain than those without, but there was no significant difference between patients with and without cartilage injury. Multiple regression analysis revealed that a high synovitis score and HU ratio of the talus were significantly associated with high pain. CONCLUSIONS Intra-articular lesions such as synovitis and BML were associated with pain in patients with CLAI. Osteosclerotic changes in the medial gutter also induced ankle pain, indicating that osteoarthritic changes had already begun. Therefore, lateral ankle ligament injuries after ankle sprain should be appropriately treated to avoid secondary degenerative changes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
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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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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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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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Kyung MG, Cho YJ, Lee J, Lee W, Kim DY, Lee DO, Lee DY. Relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis. J Orthop Surg (Hong Kong) 2022; 29:23094990211045219. [PMID: 34872417 DOI: 10.1177/23094990211045219] [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: 11/16/2022] Open
Abstract
PurposeThis study aimed to evaluate the relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis. Methods: Incongruent varus ankle osteoarthritis was defined as a talar tilt of more than 4° on standard ankle anteroposterior radiographs. We retrospectively reviewed 30 patients with unilateral incongruent varus ankle osteoarthritis with normal alignment of the contralateral ankle. All patients underwent bilateral weightbearing computed tomography and standing plain radiographs. The talar tilt and the distance between the talar lateral process and lateral malleolar tip were measured from a standing ankle anteroposterior radiograph of both sides. Talar and fibular spurs were assessed on the coronal and axial views of weightbearing computed tomography. After simulating the correction of the talar tilt in varus ankle osteoarthritis, talofibular bony impingement was reassessed. Results: On the varus side, the distance between the talar lateral process and the lateral malleolar tip was significantly shorter than that on the contralateral side (p < .001). Talar spur was present in the varus side of all 30 patients on the axial view of weightbearing computed tomography and in the control side of 10 patients. After the simulation of talar tilt correction, talofibular impingement (overlap) occurred in all 30 patients with a larger extent in the severe talar tilt subgroup (p < .001). Conclusion: Talofibular impingement by lateral gutter osteophytes is closely related to increased talar tilt in patients with incongruent varus ankle osteoarthritis. Therefore, lateral gutter osteophytes should be resected to stabilize mortise and improve clinical outcomes.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopaedic Surgery, 58927Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun Jae Cho
- Department of Orthopaedic Surgery, 371135Hanil General Hospital, Seoul, Republic of Korea
| | - Junpyo Lee
- Department of Orthopaedic Surgery, 58927Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonik Lee
- Department of Orthopaedic Surgery, 58927Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae-Yoo Kim
- Department of Orthopaedic Surgery, 65365Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Oh Lee
- Department of Orthopaedic Surgery, 58927Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, 58927Seoul National University Hospital, Seoul, Republic of Korea.,58927Seoul National University College of Medicine, Seoul, Republic of Korea
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Park YH, Kim W, Choi JW, Choi GW, Kim HJ. Comparison of the intraoperative efficacy of the powered rasp and conventional burr in arthroscopic resection of anterior ankle osteophytes. Foot Ankle Surg 2021; 27:928-933. [PMID: 33423884 DOI: 10.1016/j.fas.2020.12.009] [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] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The efficacy of the powered rasp, a new reciprocating motion device for arthroscopic resection of osteophytes, has not been verified. The aim of this study was to compare the intraoperative efficacy of the powered rasp in arthroscopic resection of anterior ankle osteophytes to that of the conventional burr. METHODS A total of 49 consecutive patients who underwent arthroscopic resection of anterior ankle osteophytes (26 patients with the conventional burr and 23 patients with the powered rasp) were retrospectively reviewed. The preoperative volume of each osteophyte was measured using computerized tomography scan and three-dimensional software. The resection time was measured by review of the individual arthroscopy video, and the estimated resection rate was calculated as the volume of osteophytes/resection time. RESULTS The preoperative volume of osteophytes was not different between the two groups (847.8 ± 685.3 mm3 in the conventional burr and 913.3 ± 605.8 mm3 in the powered rasp, p = 0.726). The resection time was 442.4 ± 216.6 s (seconds) in the conventional burr and 386.4 ± 186.3 s in the powered rasp, and the estimated resection rate was 1.8 ± 1.0 mm3/s with the conventional burr and 2.4 ± 1.3 mm3/s with the powered rasp. These measurements were not significantly different between the two groups (p = 0.340 and 0.083, respectively). CONCLUSION The intraoperative efficacy of the powered rasp did not show superiority to that of the conventional burr in arthroscopic resection of anterior ankle osteophytes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Jung Woo Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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3-T MRI of the Ankle Tendons and Ligaments. Clin Sports Med 2021; 40:731-754. [PMID: 34509208 DOI: 10.1016/j.csm.2021.05.009] [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: 11/22/2022]
Abstract
Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.
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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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Effectiveness of ankle arthroscopic debridement in acute, subacute ankle- bimalleolar, and trimalleolar fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:721-729. [PMID: 33416908 DOI: 10.1007/s00264-020-04882-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate the usefulness of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy. METHODS In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144 in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2013 and 2017. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS). RESULTS At the final follow-up (mean 38 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported 84 and 85 respectively at final follow-up. CONCLUSION Through minimally invasive visualization of intra-articular structures, ankle arthroscopy can offer an essential option for selected patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.
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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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Management of early ankle osteoarthritis through anterior joint-preserving surgery: a retrospective evaluation at mid- to long-term follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1171-1178. [PMID: 32363558 DOI: 10.1007/s00590-020-02691-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Chronic anterior ankle pain is a recognized and straightforward characteristic of anterior impingement syndrome. This retrospective study aims to evaluate outcomes, clinical and radiological results in patients affected by anterior ankle impingement, in a context of early osteoarthritis, and treated with mini-open anterior ankle arthrolysis, in the perspective to delay or avoid other demolitive surgical options, such as total ankle replacement and joint fusion. METHODS In total, 49 patients (50 feet, mean age 45 years) undergone mini-open anterior ankle arthrolysis for anterior impingement, fulfilled inclusion criteria and gave their consent and have been enlisted in the study. Patients were retrospectively reviewed with AOFAS ankle-hindfoot score and SF-36 score at a minimum follow-up of 36 months. Statistical analysis was performed. RESULTS A marked improvement was noticed in terms of preoperative clinical score (mean AOFAS score 47.32 ± 17.89) compared to follow-up clinical score (mean AOFAS score 70.66 ± 16.62; p < 0.005), and all of 8 SF-36 domains showed statistically improved (p < 0.05) from preoperative to follow-up. Statistical significance has been shown. CONCLUSIONS It is possible to consider the mini-open anterior arthrolysis, thanks to the reduction of the painful symptomatology, a valid tool for procrastinating more invasive interventions such as arthrodesis or prosthetic replacement in patients with grade 1 or 2 of ankle osteoarthritis.
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15
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Abstract
Members of the International Skeletal Society compiled a glossary of terms for musculoskeletal radiology. The authors also represent national radiology or pathology societies in Asia, Australia, Europe, and the USA. We provide brief descriptions of musculoskeletal structures, disease processes, and syndromes and address their imaging features. Given the abundance of musculoskeletal disorders and derangements, we chose to omit most terms relating to neoplasm, spine, intervention, and pediatrics. Consensus agreement was obtained from 19 musculoskeletal radiology societies worldwide.
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16
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Cosma DI, Vasilescu DE, Corbu A, Todor A, Valeanu M, Ulici A. Combined Anterolateral, Anterior, and Anteromedial Ankle Impingement in an Adolescent Soccer Player: A Case Report and Review of the Literature. Clin J Sport Med 2019; 29:e80-e82. [PMID: 31688187 DOI: 10.1097/jsm.0000000000000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A unique case of combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player is presented in this article. To the best of our knowledge, this is the only report of circumferential, massive, anterior ankle impingement in children described in the literature. The importance of proper diagnosis and treatment of such a lesion is illustrated in this case report. We also emphasize that clinical examination combined with 3D computed tomography scan reconstruction is an excellent and cost-effective imaging modality that can help with the diagnosis of anterior ankle impingement. Finally, open surgical treatment showed excellent results in an elite athlete.
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Affiliation(s)
| | | | | | | | - Madalina Valeanu
- Medical Informatics, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Alexandru Ulici
- Department of Pediatric Orthopedics, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
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17
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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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18
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Amaha K, Nimura A, Yamaguchi R, Kampan N, Tasaki A, Yamaguchi K, Kato R, Akita K. Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament. J Exp Orthop 2019; 6:2. [PMID: 30689117 PMCID: PMC6890913 DOI: 10.1186/s40634-019-0171-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background Adult acquired flatfoot deformity (AAFD) is caused by impaired medial ligamentous structures and posterior tibialis tendon dysfunction (PTTD). Although degeneration and trauma could separately cause AAFD, how these factors interact in the pathomechanism of AAFD is unclear. The joint capsule in the medial ankle is considered an important structure, providing passive stability by limiting joint movement. Previous reports on the joint capsule suggest its involvement in pathological changes of the ankle, but because of the high priority placed on the ligaments, few reports address the ankle joint from the joint capsule standpoint. The current study aimed to anatomically examine the medial ankle joint, focusing on the deltoid and spring ligaments in perspective of the joint capsule. Methods We conducted a descriptive anatomical study of 19 embalmed cadavers (mean 82.7 years, range 58 to 99). We included 22 embalmed cadaveric ankles. We detached the joint capsule in 16 ankles from the anterior to posteromedial joint, analyzed the capsular attachments of the ankle and adjacent joints, and measured the widths of the bony attachments. We histologically analyzed the joint capsule using Masson’s trichrome staining in 6 ankles. Results The capsule could be separated as a continuous sheet, including 3 different tissues. The anterior capsule was composed of fatty tissue. Between the medial malleolus and talus, the capsule was strongly connected and was composed of fibrous tissue, normally referred to as the deep deltoid ligament. The tibial attachment formed a steric groove, and the talar side of the attachment formed an elliptical depressed area. On the medial part of the subtalar and talonavicular joints, the capsule covered the joints as cartilaginous tissue, normally referred to as the superomedial ligament of the spring ligament. The outer side of the cartilaginous and fibrous tissue formed the sheath floor of the posterior tibialis tendon. Histological analysis revealed three different tissue types. Conclusions The capsules of the ankle, subtalar, and talonavicular joints could be detached as a continuous sheet. The deltoid and the superomedial ligament of the spring ligaments could be interpreted as a part of the continuous capsule, which had different histological features. Level of evidence Descriptive Laboratory Study.
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Affiliation(s)
- Kentaro Amaha
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Reiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Natnicha Kampan
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Tasaki
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Kato
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,JA Kyosai Research Institute, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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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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20
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Tantigate D, Noback PC, Bäcker HC, Seetharaman M, Greisberg JK, Vosseller JT. Anatomy of the ankle capsule: A cadaveric study. Clin Anat 2018; 31:1018-1023. [PMID: 30260053 DOI: 10.1002/ca.23219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022]
Abstract
Although bony and ligamentous injuries of the ankle are well understood, little is known about the degree to which injury of the ankle capsule can be a component of such injuries. The purpose of this study was to determine the dimensions of the ankle capsule and its relationship to adjacent structures. Thirteen fresh-frozen ankle specimens were systematically dissected. Methylene blue solution was injected to identify the dimensions of the ankle capsule. External dimensions were measured as the distance from the capsular reflection to the bony margin of the ankle. Internal dimensions were measured as the distance from the capsular attachment of the distal tibia, fibula, and talus to the cartilage margin. The anterior aspect of the capsule demonstrated the most proximal capsular reflection in all specimens. The most proximal reflections of the anteromedial, anterior middle and anterolateral capsule were 10.3, 13.5, and 9.8 mm, respectively. The most proximal reflections of the posteromedial, posterior middle and posterolateral region were 8.7, 6.2, and 3.5 mm, respectively. There was no capsular reflection over the medial malleolus and less than 1 mm over the posterior lateral malleolus. There was a confluence of the capsule and ligamentous complex on the medial side, and also with the transverse tibiofibular ligament about the posterolateral ankle. The most proximal attachment of the ankle capsule was located at the anterior aspect of the distal tibia. The medial and posterolateral capsules were confluent with the ligamentous complexes of the ankle in those regions. Clin. Anat. 31:1018-1023, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Direk Tantigate
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
- Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Peter C Noback
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
| | - Henrik C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
| | - Mani Seetharaman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
| | - Justin K Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York
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21
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Talbot CE, Knapik DM, Miskovsky SN. Prevalence and location of bone spurs in anterior ankle impingement: A cadaveric investigation. Clin Anat 2018; 31:1144-1150. [PMID: 29873114 DOI: 10.1002/ca.23216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/16/2018] [Indexed: 12/21/2022]
Abstract
Anterior ankle impingement (AAI) results from repetitive microtrauma leading to pain and decreased dorsiflexion due to spur formation and synovial hypertrophy. Information about the prevalence of anterior spur formation in a large population, and the individual contributions of the talus and tibia to osseous impingement, is limited. A total of 670 ankle specimens from 344 individuals (n = 111 females, n = 233 males) aged 20 to 40 years at the time of death were examined. Matching tibia and talus were opposed and any spurring causing impingement was recorded. Spur locations were measured and ratios calculated to allow for inter-specimen comparison between: (1) medial-to-lateral and anterior-to-posterior spur location versus dimensions of talar neck width, and (2) medial-to-lateral spur location to dimensions of distal anterior tibial width. Differences in spur prevalence in relation to sex, race, height and age were identified by univariant and multivariable statistical analyses. Bony impingement was observed in 21% (n = 72) of specimens, with bilateral involvement in 8% (n = 27). For ankles with AAI, spurs were seen on the talus only in 61%, on the tibia only in 14%, and on both the tibia and talus in 26%. Spurs were significantly more prevalent in males (P = 0.001) and with increasing specimen age (P = 0.002). There were no significant differences related to specimen height or race. Spurs were predominately located on the anterolateral talus (78%) and the anterolateral portion of the distal tibial margin (80%). AAI was present in 21% of young osseous specimens and was significantly more prevalent in males and with increasing specimen age. Clin. Anat. 31:1144-1150, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Derrick M Knapik
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shana N Miskovsky
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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22
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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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24
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Blanchard S, Palestri J, Guer JL, Behr M. Current Soccer Footwear, Its Role in Injuries and Potential for Improvement. Sports Med Int Open 2018; 2:E52-E61. [PMID: 30539118 PMCID: PMC6259463 DOI: 10.1055/a-0608-4229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/24/2018] [Accepted: 03/30/2018] [Indexed: 01/07/2023] Open
Abstract
Soccer is the most popular sport in the world and generates great financial revenue. It is also a sport whose practice has evolved considerably in terms of intensity and commitment, and in which the intrinsic risk of injury (not directly related to an interaction with the environment) is particularly high. In this context, the cleated shoe as a major component of soccer equipment may play a key role in the overexposure to injury. Soccer shoe evolution is all the more challenging, because design and mechanical structure differ in many points compared to other modern shoes developed for sports such as running, tennis and basketball. This critical review aims to elucidate the characteristics of modern soccer footwear and their possible link to soccer-specific injuries, focusing on the following areas: (1) ergonomics, comfort and proprioception; (2) shoe mechanical characteristics; (3) field surfaces and shoe design.
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Affiliation(s)
- Sylvain Blanchard
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - Jean-Luc Guer
- Wizwedge SARL, Research Department, Marseille, France
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
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25
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Abstract
Impingement syndrome of the ankle is a clinical diagnosis caused posttraumatically by overuse due to repetitive mechanical loading or the presence of predisposing anatomical variants. Ankle impingement syndrome is characterized by chronic pain and limited range of movement caused by mechanical compression of bony or soft tissues within the joint compartments. Ankle impingement syndrome is classified according to the various anatomical locations around the tibiotalar joint as anterior, anterolateral, anteromedial, posterior or posteromedial. Various imaging modalities are helpful in confirming the clinical diagnosis of ankle impingement. Radiography and computed tomography are used to identify bony abnormalities and intra-articular loose bodies. Magnetic resonance imaging is the modality of choice to demonstrate pathological soft tissue changes, bone marrow edema and osteochondral lesions. Dynamic sonography can identify the anatomical structures leading to impingement during movement.
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Affiliation(s)
- R-I Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Wien, Österreich
| | - L B Fritz
- Rheinlandärzte, Willich & Meerbusch, Willich, Deutschland
| | - C Schueller-Weidekamm
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich. .,Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Wien, Österreich.
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26
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Nazarian LN, Gulvartian NV, Freeland EC, Chao W. Ultrasound-Guided Percutaneous Needle Fenestration and Corticosteroid Injection for Anterior and Anterolateral Ankle Impingement. Foot Ankle Spec 2018; 11:61-66. [PMID: 28506083 DOI: 10.1177/1938640017709904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ankle impingement is a common cause of chronic ankle pain. We retrospectively studied the effectiveness of ultrasound-guided percutaneous needle fenestration of the pathological soft tissues combined with corticosteroid injection to treat this condition. METHODS We administered a telephone survey to patients who underwent the procedure. Patients were asked questions on the Foot Function Index and queried about their overall satisfaction with the procedure on a scale of 0 (completely unsatisfied) to 10 (very satisfied). RESULTS Forty-nine patients participated in the survey: 26 women and 23 men, mean age 42.7 years (range, 19-65 years). Impingement was anterior in 26/49 (53.1%), anterolateral in 14/49 (28.6%), and both in 9/49 (18.4%). Mean pain level before the procedure was 6.76 ± 1.84 and after the procedure was 2.73 ± 2.21. Reported pain scale levels declined by 4.02 ± 2 units after the procedure (P < .0001). Patient's overall satisfaction was 7.9 ± 2.44. CONCLUSIONS Ultrasound-guided percutaneous needle fenestration and corticosteroid injection appears to be an effective nonoperative alternative for treatment of anterior and/or anterolateral ankle impingement. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (LNN, NVG).,Cooper Medical School of Rowan University, Camden, New Jersey (ECF).,Pennsylvania Orthopaedic Foot and Ankle Surgeons, Pennsylvania Hospital, Philadelphia, Pennsylvania (WC)
| | - Nar V Gulvartian
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (LNN, NVG).,Cooper Medical School of Rowan University, Camden, New Jersey (ECF).,Pennsylvania Orthopaedic Foot and Ankle Surgeons, Pennsylvania Hospital, Philadelphia, Pennsylvania (WC)
| | - Erik C Freeland
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (LNN, NVG).,Cooper Medical School of Rowan University, Camden, New Jersey (ECF).,Pennsylvania Orthopaedic Foot and Ankle Surgeons, Pennsylvania Hospital, Philadelphia, Pennsylvania (WC)
| | - Wen Chao
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (LNN, NVG).,Cooper Medical School of Rowan University, Camden, New Jersey (ECF).,Pennsylvania Orthopaedic Foot and Ankle Surgeons, Pennsylvania Hospital, Philadelphia, Pennsylvania (WC)
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27
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Anandkumar S. Effect of a novel mobilization with movement procedure on anterolateral ankle impingement - A case report. Physiother Theory Pract 2018; 34:569-577. [PMID: 29297724 DOI: 10.1080/09593985.2017.1422822] [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: 10/18/2022]
Abstract
This case report describes a 50-year-old male who presented with right anterolateral ankle pain managed unsuccessfully with rest, medications, bracing, injection, physical therapy, and massage therapy. Clinical diagnosis of anterolateral ankle impingement was based on concordant symptom reproduction with palpatory tenderness and a positive lateral synovial impingement test. This case report is a potential first time description of the successful management of anterolateral ankle impingement utilizing a novel Mulligan's mobilization with movement procedure (consisting of internal rotation of the distal tibia) and taping with immediate improvements noted in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 4 months revealed that the patient was pain free and fully functional.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI Health Centre, Chilliwack , British Columbia , Canada
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28
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Molinier F, Benoist J, Colin F, Padiolleau J, Guillo S, Stone J, Bauer T. Does antero-lateral ankle impingement exist? Orthop Traumatol Surg Res 2017; 103:S249-S252. [PMID: 28893616 DOI: 10.1016/j.otsr.2017.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
Antero-lateral ankle impingement syndrome (ALAIS) is a well-established clinical entity that is a common consequence of ankle sprains. Injury to the anterior talo-fibular ligament plays a key role in the genesis of ALAIS. Arthroscopic antero-lateral synovectomy is the standard of care. However, this treatment approach may deserve to be challenged, as it does not include any procedure on the ligaments, despite the presence in some patients of lateral rotational micro-instability of the ankle, without objective laxity. Consequently, we reviewed current data on ALAIS and its links to ankle instability, from the dual perspective of diagnosis and treatment.
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Affiliation(s)
- F Molinier
- Clinique des Cèdres, Château d'Alliez, 31700 Cornebarrieu, France
| | - J Benoist
- CHP Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - F Colin
- Clinique mutualiste Catalane, 60, rue Louis-Mouillard, 66028 Perpignan, France
| | - J Padiolleau
- Polyclinique de l'Atlantique, avenue Claude-Bernard, 44819 Saint-Herblain, France
| | - S Guillo
- Clinique du sport, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - J Stone
- Mid West orthopedic specialty hospital, orthopedic institute of Wisconsin, Milwaukee, WI, USA
| | - T Bauer
- CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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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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Ross KA, Murawski CD, Smyth NA, Zwiers R, Wiegerinck JI, van Bergen CJA, Dijk CNV, Kennedy JG. Current concepts review: Arthroscopic treatment of anterior ankle impingement. Foot Ankle Surg 2017; 23:1-8. [PMID: 28159036 DOI: 10.1016/j.fas.2016.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 09/30/2015] [Accepted: 01/27/2016] [Indexed: 02/04/2023]
Abstract
Anterior ankle impingement is a common cause of chronic ankle pain, particularly in athletic populations. Morris and McMurray provided the earliest descriptions of anterior impingement, coining the condition as "athlete's ankle" or "footballer's ankle". The pathology has since been a topic of considerable investigation and has been re-termed "anterior ankle impingement syndrome". Treatment with open surgery has provided good results historically, but at the price of significant complications. Advancements in ankle arthroscopy have decreased the risk of complication drastically and evidence in the literature indicates that anterior arthroscopy is an effective approach to treating osseous and soft tissue impingement. Effective clinical diagnosis and diagnostic imaging are critical for pre-surgical planning. Preoperative detection of anterior osteophytes has been correlated with outcomes. Factors such as joint space narrowing and large osteophytes may also influence outcomes. Therefore, a comprehensive understanding of diagnosis and surgical technique can influence patient outcomes, and patient expectations can be managed around prognostic indicators such as the presence of osteoarthritis. The purpose of this review is to discuss the etiology, clinical presentation, diagnosis, surgical technique, and postoperative rehabilitation of anteromedial and anterolateral anterior ankle impingement syndrome and to evaluate the evidence-based outcomes of arthroscopic management.
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Affiliation(s)
- Keir A Ross
- Hospital for Special Surgery, Department of Orthopaedic Surgery, 523 E 72nd Street, East River Professional Building, Ste 507, New York, NY 10021, United States
| | - Christopher D Murawski
- Hospital for Special Surgery, Department of Orthopaedic Surgery, 523 E 72nd Street, East River Professional Building, Ste 507, New York, NY 10021, United States; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Niall A Smyth
- Hospital for Special Surgery, Department of Orthopaedic Surgery, 523 E 72nd Street, East River Professional Building, Ste 507, New York, NY 10021, United States
| | - Ruben Zwiers
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands
| | - Johannes I Wiegerinck
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands
| | - Christiaan J A van Bergen
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands
| | - Cornelis Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands
| | - John G Kennedy
- Hospital for Special Surgery, Department of Orthopaedic Surgery, 523 E 72nd Street, East River Professional Building, Ste 507, New York, NY 10021, United States.
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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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32
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Abstract
Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.
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Affiliation(s)
- Kyle P Lavery
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Kevin J McHale
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - William H Rossy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - George Theodore
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
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33
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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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Abstract
BACKGROUND Talofibular bony impingement has not previously been reported, since it is difficult to detect on plain radiograph, similar to the spur on the anterior border of the medial malleolus and anterior portion of the medial talar facet. We hypothesized that talofibular bony impingement can cause limited dorsiflexion of the ankle. The aim of this study was to evaluate talofibular bony impingement as a distinct form of impingement that limits dorsiflexion of the ankle. METHODS This study included 20 consecutive patients (21 ankles) with talofibular impingement and 19 consecutive patients (19 ankles) with lateral ankle instability without talofibular impingement. Presence or absence of talofibular impingement was confirmed under direct intraoperative visualization. Dorsiflexion before and after excision of the impinging spurs was measured. Findings on plain radiographs and computed tomography were compared between the groups. Pre- and postoperative clinical assessments were done with Foot Function Index, visual analog scale for pain, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score at a mean follow-up of 1.4 years. RESULTS After removal of the bony impingement, the range of dorsiflexion increased by a mean 7.9 degrees (range, 2.5 to 11.0 degrees) in the impingement group. The mean distance between the fibula and lateral process of the talus on weight- bearing anteroposterior radiograph of the ankle was 1.2 mm (range, 0 to 4.5) in the impingement group and 3.2 mm (range, 1 to 4.5) in the control group. On axial computed tomography image, bony protrusion of the lateral process of the talus was frequently present in the impingement group, and the mean amount of protrusion was more than that of the control group. Clinical findings improved overall. CONCLUSIONS Talofibular impingement was a cause of limited dorsiflexion, and the diagnosis was confirmed intraoperatively. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ji-Yong Ahn
- Department of Orthopaedic Surgery, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijenong bu si, Gyeonggi-do, Republic of Korea
| | - Hong-Joon Choi
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Woo-Chun Lee
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Institute for Research of Foot and Ankle Diseases, Inje University, Seoul, South Korea
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Anatomie und arthroskopische Befunde. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gross CE, Nunley JA. Medial-sided Stress Fractures: Medial Malleolus and Navicular Stress Fractures. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Walsh SJ, Twaddle BC, Rosenfeldt MP, Boyle MJ. Arthroscopic treatment of anterior ankle impingement: a prospective study of 46 patients with 5-year follow-up. Am J Sports Med 2014; 42:2722-6. [PMID: 25261086 DOI: 10.1177/0363546514550976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Midterm outcomes after arthroscopic debridement in patients with anterior ankle impingement without osteoarthritis are currently unclear. PURPOSE To assess the functional and radiological outcomes after arthroscopic treatment of anterior ankle impingement with a minimum 5-year follow-up in patients without osteoarthritis. STUDY DESIGN Case series; Level of evidence, 4. METHODS From September 1999 to March 2006, a consecutive series of eligible patients without ankle osteoarthritis and with anterior ankle impingement, who had persistent ankle pain and activity restrictions despite at least 6 months of nonoperative management, underwent standardized arthroscopic debridement and followed uniform postoperative management. Patients were assessed preoperatively and at 6 weeks, 6 months, and 12 months and then at 1-year intervals after surgery until a minimum of 5 years' follow-up had been achieved, with weightbearing ankle dorsiflexion, Foot Functional Index (FFI), and plain radiography including Scranton and McDermott classification (SMC) grade and tibial osteophyte size. RESULTS A total of 46 patients (42 male, 4 female) were prospectively assessed, with a mean age at surgery of 29 years (range, 16-44 years) and a mean follow-up duration of 5.1 years (range, 5.0-7.5 years). Preoperative ankle radiographs demonstrated a median SMC grade of 2 and a mean tibial osteophyte size of 5.1 mm. At a minimum of 5 years postoperatively, patients demonstrated limited improvement in ankle dorsiflexion (mean, 24.7° [preoperatively] vs 27.0° [final follow-up]; P = .049); however, they demonstrated substantial improvement in the FFI (mean, 20.5 [preoperatively] vs 2.7 [final follow-up]; P < .001). Postoperatively, 84% of patients showed a recurrence of radiological osteophytes, with plain radiographs at final follow-up demonstrating no significant difference in the SMC grade (P = .107) or tibial osteophyte size (P = .212) compared with preoperative imaging. There was no significant effect of patient age, sex, body mass index, or SMC grade at the time of surgery on any of the postoperative outcome measures. CONCLUSION In this prospective outcome study of 46 patients without osteoarthritis managed arthroscopically for anterior ankle impingement, the functional outcome scores had significantly improved at 5 years postoperatively despite a recurrence of radiographic osteophytes.
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Affiliation(s)
| | - Bruce C Twaddle
- Unisports Sports Medicine, Auckland, New Zealand Sports Medicine Center at Husky Stadium, Seattle, Washington, USA
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38
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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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39
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Parma A, Buda R, Vannini F, Ruffilli A, Cavallo M, Ferruzzi A, Giannini S. Arthroscopic treatment of ankle anterior bony impingement: the long-term clinical outcome. Foot Ankle Int 2014; 35:148-55. [PMID: 24174431 DOI: 10.1177/1071100713510912] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic treatment of anterior ankle bony impingement provides good results, with a tendency to decrease over time. The purpose of this study was to analyze the factors affecting long-term results. METHODS Eighty consecutive patients with a mean age of 37.3 years were treated between 2000 and 2004. Impingement lesions were identified according to Scranton-McDermott classification. Preoperative ankle osteoarthritis was documented by van Dijk scale upon the x-rays. Bone spurs were analyzed and classified according to location and size. The associated chondral lesions were classified following the International Cartilage Repair Society (ICRS) criteria. Patient data, foot morphology, and previous traumas were recorded. Patients were evaluated after a mean of 104.6 months follow-up with the American Orthopaedic Foot and Ankle Society (AOFAS) scale. The influence of different factors on outcomes was statistically analyzed. RESULTS The mean preoperative AOFAS score was 50.9, while at follow-up it was 70.7 (P < .05). The different grades of Scranton-McDermott impingement classification did not affect the results, but the different grades of van Dijk scale significantly affected the result but not the preoperative stage. Tibial localized spurs had better outcome at follow-up. The grade of the chondral lesions significantly affected the outcome. Other factors negatively affecting the results were age, cavus foot morphology, and history of previous ankle fracture. CONCLUSION Arthroscopic treatment provides overall good results, but the long-term presence of associated conditions such as chondral lesions, advanced age, and previous trauma are relevant as prognostic factors. Based on these results, a new classification for bony impingement syndrome system is proposed. LEVEL OF EVIDENCE Level IV, case series.
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41
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Abstract
Context: Medial impingement syndrome of the ankle is common in the athletic population. A marginal osteophyte on the leading edge of the medial talar facet and a corresponding “kissing” osteophyte on the tibia, in front of the medial malleolus, may abut and cause pain and limited dorsiflexion. Background: Palpation of the talar osteophyte and standard imaging—especially, the oblique view of the foot—are useful in making the diagnosis. Surgical removal of the osteophyte may be necessary. Conclusions: Ankle impingement is commonly seen in running and jumping sports, especially if the athlete has a subtle cavus foot. It may be associated with ankle instability, osteochondritis dissecans of the talus, and stress fractures of the foot.
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Affiliation(s)
- Arthur Manoli
- Michigan International Foot and Ankle Center, Pontiac, Michigan ; Orthopaedic Surgery, Wayne State University, Detroit, Michigan ; Michigan State University, East Lansing, Michigan
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42
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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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43
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Arnold H. Posttraumatic impingement syndrome of the ankle--indication and results of arthroscopic therapy. Foot Ankle Surg 2011; 17:85-8. [PMID: 21549978 DOI: 10.1016/j.fas.2010.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 01/10/2010] [Accepted: 01/24/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persisting pain after an ankle sprain is often caused by the development of intraarticular fibrous scars or even tibiotalar spurs due to repetitive trauma. This may result in a posttraumatic impingement syndrome of the ankle. Pain is typically provoked by dorsiflexion of the ankle and palpation of the tibiotalar anterior joint space. The study evaluates the outcome of arthroscopic treatment of the ankle impingement syndrome. METHODS 32 patients are included (16-65 years, mean age 38 years) who underwent an arthroscopic operation because of an impingement syndrome of the ankle grades I-III (Scranton) due to a trauma without therapeutic response to conservative therapy over 3 months. Diagnostic criteria were palpatoric anterior ankle joint pain and pain provoked by dorsiflexion, in cases of grades II and III lesions spurs on the X-ray as well. The mean follow-up time was 49 months. The evaluation of the results was done with the West Point Ankle Score. The study is designed as a retrospective case series. RESULTS 26 patients reached more than 80 points in the West Point Ankle Score corresponding to a good or excellent result (mean result 86 points, ranging from 80 to 98 points). The preoperative mean score reached up to 64 points overall (57-70). Five patients rated the postoperative result fair, one bad with 73 points at mean (62-78). Preoperatively they reached 56 point on an average (48-62). The fair and the poor results were associated with severe ankle sprain leading to ligament ruptures or fractures where severe chondral lesions were to be found with arthroscopy. CONCLUSIONS The results of the study show that ankle arthroscopy with resection of hypertrophic synovium and fibrous bands (type I) or tibial spurs (types II and III injuries) after an ankle sprain haven proven to be a reliable therapy for a posttraumatic impingement syndrome of the ankle that does not respond to conservative treatment. It is characterized by low morbidity and good to excellent results in most cases. The outcome of arthroscopic treatment was related to the extent of chondral lesions.
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Affiliation(s)
- Heino Arnold
- Orthopädisch-Unfallchirurgische Praxisklinik Rehau, Orthopädisches Zentrum Fichtelgebirge, Bahnhofstraße 10, 95111 Rehau, Germany.
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44
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Abstract
Arthroscopy of the foot and ankle, although sometimes technically challenging, is a useful tool for the foot and ankle surgeon. Burman in 1931 was the first to attempt arthoscopy of the ankle joint and surmised that it was not a suitable joint for arthroscopy because of its narrow intra-articular space. With the development of smaller-diameter arthroscopes and improvements in joint distraction techniques, Watanabe was the first to present a series of 28 ankle arthroscopes in 1972. At present, arthroscopy is used not only to evaluate and treat intra-articular abnormalities but also for endoscopic and tendoscopic procedures.
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Affiliation(s)
- Meagan M Jennings
- Department of Podiatry, Palo Alto Medical Foundation, Mountain View, CA 94040, USA.
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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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Murawski CD, Kennedy JG. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. Am J Sports Med 2010; 38:2017-24. [PMID: 20479141 DOI: 10.1177/0363546510369335] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic debridement is a well-accepted method of removing osseous and/or soft tissue impingement from the ankle joint. To the best of the authors' knowledge, this is the first case series reporting the outcomes following arthroscopic resection of anteromedial impingement. PURPOSE The authors report the results at a minimum 2-year follow-up of 41 patients who underwent arthroscopic resection for anteromedial impingement. STUDY DESIGN Case series; Level of evidence, 4. METHODS Arthroscopic surgery for anteromedial impingement was performed on 43 patients under the care of the senior surgeon between January 2005 and July 2007; 41 patients were included in the present study. All patients were assessed preoperatively and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and Short Form 36 (SF-36v2) outcome scores. The mean patient age at the time of surgery was 31.12 years (range, 13-57 years). The mean follow-up time was 34.41 months (range, 24-52 months). Thirty-four patients (83%) were competing at some level of athletic sport. RESULTS Thirty-eight patients (93%) were satisfied with the procedure. The AOFAS scores improved from 62.83 points preoperatively to 91.17 points postoperatively (range, 61-100 points) (P < .001). The SF-36v2 scores improved from 61.54 points preoperatively to 92.21 points postoperatively (range, 58-100 points) (P = .002). All but 1 patient returned to their prior level of sporting activity. Three patients (7%) reported a complication. CONCLUSION Arthroscopic resection for anteromedial impingement provides excellent functional outcomes, thereby allowing the athlete an expedited return to sport at previous levels of competition.
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Abstract
Anterior impingement is a common problem in dancers occurring primarily secondary to the repetitive forced ankle dorsiflexion inherent in ballet. Symptoms generally occur progressively and may respond to conservative treatment including addressing biomechanical faults that contribute to the problem. As impingement progresses, movements essential to ballet may become impossible and arthroscopic ankle surgery is often effective for both diagnosis and treatment, allowing athletes to return to dance.
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Affiliation(s)
- John William O'Kane
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Anterior ankle bony impingement with joint motion loss: the arthroscopic resection option. Orthop Traumatol Surg Res 2010; 96:462-8. [PMID: 20488775 DOI: 10.1016/j.otsr.2010.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 11/23/2009] [Accepted: 01/18/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study presents an arthroscopic surgery technique for the treatment of bony anterior ankle impingement with tibiotalar joint stiffness, and initial short-term results. SURGICAL TECHNIQUE All patients underwent the same arthroscopic technique, with anterior ankle synovectomy, osteophyte resection and extensive anterior capsuloligamentous structures release. Rehabilitation was immediately initiated. SERIES: This was a retrospective series of 13 cases of bony ankle impingement associated with poorly tolerated range of motion restriction. At a mean 15 months' follow-up, 10 out of 13 patients were satisfied or very satisfied with their result, and three were disappointed. Anterior impingement symptoms had entirely disappeared in 12 of the 13 cases. Five patients showed persistent deep pain. Mean dorsiflexion improved from 7 degrees to 16 degrees (p<0.009) and mean plantar flexion from 20 degrees to 34 degrees (p<0.004). Mean AOFAS score improved from 67/100 (54-80) to 87/100 (43-100) (p<0.05). DISCUSSION In the particular case of bony ankle impingement associated with poorly tolerated range of motion restriction, both pain and joint mobility can be improved by simple arthroscopic surgical techniques combining anterior synovectomy, extensive anterior capsuloligamentous release, large-scale osteophyte resection and malleolar groove release. Surgery should immediately be followed by a program of mobilization and rehabilitation in hospital, with pain management. Short-term results are encouraging, providing clear functional improvement and overall ankle mobility gain. LEVEL OF EVIDENCE Level IV, retrospective series.
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