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Chen X, Huang HQ, Duan XJ. Arthroscopic treatment of ankle impingement syndrome. Chin J Traumatol 2023; 26:311-316. [PMID: 37852876 PMCID: PMC10755808 DOI: 10.1016/j.cjtee.2023.09.006] [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: 08/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
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Affiliation(s)
- Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - He-Qin Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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Chuckpaiwong B, Reingrittha P, Harnroongroj T, Mawhinney C, Tharmviboonsri T. Sport and Exercise Activity After Isolated Ankle Arthrodesis for Advanced-Stage Ankle Osteoarthritis: A Single-Center Retrospective Analysis. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231177310. [PMID: 37325694 PMCID: PMC10262617 DOI: 10.1177/24730114231177310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background Ankle arthrodesis, a recognized operative treatment for advanced-stage ankle osteoarthritis (OA), is recommended when conservative treatment proves unsuccessful. This single-center retrospective analysis examined the change in functional outcomes and the type of sport/exercise activity performed by advanced-stage ankle OA patients after ankle arthrodesis treatment. Methods A total of 61 advanced-stage ankle OA patients (age, 63.1 ± 12.6 years) who had undergone ankle arthrodesis were included in this single-center retrospective study. The patients had functional outcomes evaluated via American Orthopaedic Foot & Ankle Society Score (AOFAS), Foot Function Index (FFI), Tegner Activity Level Scale (TAS), and High-Activity Arthroplasty Score (HAAS) questionnaires. Clinical status was compared across prearthritic, arthritic, and postarthrodesis periods, and satisfaction with return to sport/exercise activity was recorded. Results Patients' tarsal sagittal ROM (mean [95% CI]: 22.7 degrees [21.4-24.0]); time to union (15.7 weeks [11.8-19.6]); time to walk without gait aid (14.4 weeks [11.0-17.7]); time to return to work (17.9 weeks [15.1-20.8]); and time to exercise activity (20.6 weeks [17.9-23.4]) were recorded postarthrodesis. Hindfoot alignment angle toward a neutral position (difference: 11.4 degrees [9.2-13.6], P < .001) and functional outcomes (P < .001) significantly improved after arthrodesis surgery; however, only the TAS questionnaire indicated patients returned to their prearthritic activity level (P > .99). Patients generally reported "good" satisfaction with their recovery from ankle arthrodesis surgery, with 64% of patients returning to high-impact-type activity. Conclusion Advanced-stage ankle OA patients had improved functional outcomes at ~1 year postarthrodesis surgery, enabling the majority of patients to return to high-impact-type activity. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Orthopaedic Surgery and Rehabilitation department, Siriraj Hospital, Bangkok, Thailand
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Pissanu Reingrittha
- Orthopaedic Surgery and Rehabilitation department, Siriraj Hospital, Bangkok, Thailand
- Orthopedics Department, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Thos Harnroongroj
- Orthopaedic Surgery and Rehabilitation department, Siriraj Hospital, Bangkok, Thailand
| | - Chris Mawhinney
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
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Schwartz AM, Niu S, Mirza FA, Thomas AR, Labib SA. Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport. J Foot Ankle Surg 2021; 60:1188-1192. [PMID: 34130931 DOI: 10.1053/j.jfas.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Talus osteochondral lesions are a commonly underdiagnosed problem in young athletes. Talus osteochondral lesions surgical algorithm remains controversial. Current metrics suggest that conventional treatment of osteochondral lesions of the talus is promising; yet return to sport is poorly studied. Fifty-seven patients following talus osteochondral lesion surgical intervention were included in this study. About 63.1% were female with mean age 37.1 years, mean lesion size 10 × 12.5 mm, and mean follow-up 79.9 months postoperatively. Patients were divided into 4 groups by surgery performed: antegrade arthroscopic bone marrow stimulation, retrograde arthroscopic drilling, osteochondral autograft transfer, and allograft cartilage implantation. Outcome metrics include Visual Analog Scale for pain and function, Short Form-12, Foot and Ankle Disability Scale, Tegner, Marx activity scores, Naal Sports inventory, and patient satisfaction. Over 77% of patients were satisfied with surgical intervention. Each intervention significantly decreased pain and increased function, except retrograde drilling. All interventions trended toward decreased Tegner score; only antegrade drilling showed significant decrease. Based on Naal's sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Traditionally, talus osteochondral lesions present a difficult problem that is marred by unsatisfactory nonoperative outcomes in typically active patients. As our surgical understanding has evolved, we've continued to improve on outcomes. Our patients demonstrated 77.2% overall satisfaction rate, a statistically significant improvement in pain and function, at an average follow-up of 79.9 months postoperatively, and a high rate of return to sport with little difference between surgical interventions.
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Affiliation(s)
| | - Shuo Niu
- Emory University School of Medicine, Atlanta, GA
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Mattos E Dinato MC, Pereira Filho MV, Pagnano RG. Endoscopy for the treatment of posterior ankle impact syndrome: Learning curve. Foot Ankle Surg 2021; 27:755-759. [PMID: 33082098 DOI: 10.1016/j.fas.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/23/2020] [Accepted: 09/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to demonstrate our learning curve of endoscopy for the treatment of Posterior Ankle Impact Syndrome (PAIS), assessing the operative time and evolution of the outcomes. METHODS We conducted a retrospective review of 39 patients submitted to endoscopic treatment by a single surgeon over a period of ten years. We divided the study population into four blocks of ten consecutive patients and compared the mean operative time and outcomes between the four blocks. For the learning curve model, we performed linear regression analysis and logarithmic transformation. RESULTS We found a decrease in the surgery duration over time (P = .0273). All patients had an improvement in the AOFAS Scale (P < .0001), regardless of the group (P = .07). The learning rate was estimated at 83%, indicating a 17% reduction of the operative time as the cumulative cases doubled. CONCLUSIONS This study showed a decrease in the operative time of the posterior ankle endoscopy over the years, with an estimated learning rate of 83%. The outcomes and incidence of complications showed no relationship with operative time and the number of cases operated. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mauro C Mattos E Dinato
- School of Medical Sciences, State University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", 13083-887 - Campinas, SP, Brazil; Instituto Vita, Rua Mato Grosso, 306 1º andar, 01239-040 - São Paulo, SP, Brazil
| | - Miguel V Pereira Filho
- Hospital Sancta Maggiore / Prevent Senior, Rua Maestro Cardim, 1137 - Liberdade, 01323-001 - São Paulo, SP, Brazil
| | - Rodrigo G Pagnano
- School of Medical Sciences, State University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", 13083-887 - Campinas, SP, Brazil.
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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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Symeonidis PD, Papakostas ET, Marín Fermín T, Tsatlidou M, Terzidis I, Papadopoulos P. Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda's process resection in patients with posterior ankle impingement syndrome: a prospective comparative study. J ISAKOS 2021; 6:329-332. [PMID: 34193616 DOI: 10.1136/jisakos-2021-000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the potential differences in American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot Function Index (FFI) at 6-month and 12-month postoperative follow-up of arthroscopic treatment for posterior ankle impingement (PAIS) between os trigonum (OT) and Stieda's process (SP) patients. METHODS Thirty consecutive patients (32 ankles) treated in our Institution for PAIS with posterior arthroscopy were prospectively enrolled in the study from December 2012 to July 2019. Indications were patients with PAIS with persistent symptoms following conservative management. Exclusion criteria were the coexistence of concomitant pathologies and patients who underwent additional surgical procedures. An independent investigator interviewed and evaluated the patients according to the AOFAS hindfoot score and FFI preoperatively, at 6-month and 12-month follow-up. RESULTS Except for AOFAS scores in the SP group (MD (mean difference) 11.28, p=0.08), patients undergoing arthroscopic treatment for bony PAIS had an overall significant improvement in AOFAS score (OT MD 22.29, p<0.05) and FFI (OT MD -70.07, p<0.05; SP MD -50.96, p<0.05) from their preoperative scores at 6-month follow-up. Similarly, a significant improvement in AOFAS score (OT MD 5.78, p=0.01; SP MD 12.14, p<0.05) and FFI (OT MD -9.36, p=0.04; SP MD -26.43, p<0.05) was observed from the 6-month to 12-month follow-up in all groups. At 6-month follow-up, the OT group had significantly better FFI outcomes (MD -33.57, p=0.04) compared with the SP group. No differences were found by group when comparing AOFAS score and FFI score at 12-month follow-up. CONCLUSIONS When comparing patients undergoing OT excision or SP resection, better FFI outcomes were observed in the OT group at 6-month follow-up. LEVEL OF EVIDENCE Prospective comparative study. Level II.
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Affiliation(s)
| | - Emmanouil T Papakostas
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece
| | - Theodorakys Marín Fermín
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece .,Department of Traumatology, Hospital Universitario Periférico de Coche, Caracas, Venezuela
| | | | - Ioannis Terzidis
- St. Luke's Hospital, Thessaloniki, Greece.,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopedic Department, General Hospital of Thessaloniki Gennimatas, Thessaloniki, Greece
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Causes of delayed diagnosis of posterior ankle impingement in the pediatric and adolescent population. Foot (Edinb) 2021; 47:101799. [PMID: 33957524 DOI: 10.1016/j.foot.2021.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 03/24/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to identify and characterize various causes of delay in the diagnosis of posterior ankle impingement syndrome (PAIS) in pediatric patients. METHODS IRB approved prospective study of patients under 18 years who underwent arthroscopic surgery for the diagnosis of posterior ankle impingement after failed conservative treatment at a tertiary children's hospital. Radiographic findings were compared with an age-matched control group. Descriptive and inferential statistics were employed. RESULTS 47 patients (61 ankles), mean age 13 years, had an average 14 months delay in diagnosis of PAIS from the initial presentation. 33 (70%) patients had seen multiple medical providers and given other diagnoses. 9 (19%) patients participated in ballet or soccer, and 16 (34%) patients had unrelated associated foot and ankle diagnoses. 25 (41%) of 61 ankles did not have pain on forced plantar flexion; all 61(100%) ankles had tenderness to palpation over the posterior ankle joint line. Radiographs were reported to be normal in 37/52 (71%) ankles, while MRI report did not mention the diagnosis in 20/41 (49%) studies. There was a significant difference in the MRI findings in the patient population when compared to the control group. Indication for surgery was failed conservative treatment. All 61 ankles had posterior ankle impingement pathology confirmed visually during arthroscopy. At average 15 months follow-up, there was significant improvement pre- to post-operatively (p<0.001) for both pain VAS (6.9-0.9) and AOFAS ankle-hindfoot scores (65-94). CONCLUSION Multiple clinical and imaging factors can lead to delayed diagnosis of posterior ankle impingement. An increased awareness about the features of PAIS is needed amongst medical providers involved in treating young patients.
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Nery C, Baumfeld D. Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment. Foot Ankle Clin 2021; 26:155-172. [PMID: 33487238 DOI: 10.1016/j.fcl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft tissue or osseous abnormality affecting the anterior or posterior tibiotalar joint. Impingement can be associated with a single traumatic event or repetitive microtrauma. These syndromes are a possible etiology of persistent ankle pain. An arthroscopic approach to this pathology, when indicated, is considered as ideal treatment with its high safety and low complication rate. We describe the clinical and potential imaging features, and the arthroscopic/endoscopic management strategies, for the 4 main impingement syndromes of the ankle: anterolateral, anterior, antero-medial, and posterior.
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Affiliation(s)
- Caio Nery
- UNIFESP - Federal University of São Paulo, Brazil
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9
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Rare injury of the foot: Os trigonum fracture: A case report. Jt Dis Relat Surg 2020; 31:626-629. [PMID: 32962600 PMCID: PMC7607930 DOI: 10.5606/ehc.2020.74530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os trigonum fractures are seen rarely. Our patient was a 16-year-old male patient who applied to our emergency service with right ankle pain due to acute hyperplantar flexion while playing football. There was a swelling on the right ankle and he had difficulty in walking. Os trigonum fracture was detected at lateral X-ray of the right ankle. No additional injury was detected with computed tomography and magnetic resonance imaging (MRI). Patient was treated conservatively. A short leg cast was applied. Cast was removed after six weeks and range of motion exercises were started. Union of fracture was seen on X-ray at six weeks from injury. Conservative treatment is thought to be a good option in these fractures. Computed tomography and MRI are important in the differential diagnosis and evaluation of additional injuries in this type of fracture.
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Sharpe BD, Steginsky BD, Suhling M, Vora A. Posterior Ankle Impingement and Flexor Hallucis Longus Pathology. Clin Sports Med 2020; 39:911-930. [PMID: 32892975 DOI: 10.1016/j.csm.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Posterior ankle pain is a common complaint, and the potential causative pathologic processes are diverse. The constellation of these numerous etiologies has been collectively referred to as posterior ankle impingement syndrome. The pain associated with posterior ankle impingement is caused by bony or soft tissue impingement of the posterior ankle while in terminal plantar flexion. This condition is most frequently encountered in athletes who participate in sports that involve forceful, or repetitive, ankle plantar flexion. This article discusses the associated pathology, diagnosis, conservative treatment, and surgical techniques associated with flexor hallucis longus and posterior ankle impingement syndrome.
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Affiliation(s)
- B Dale Sharpe
- Residency Program, OhioHealth Orthopedic Surgery, 5100 West Broad Street, Columbus, OH 43228, USA
| | - Brian D Steginsky
- OhioHealth Orthopedic Surgeons, 303 East Town Street, Columbus, OH 43215, USA.
| | - Mallory Suhling
- Illinois Bone and Joint Institute, LLC, 720 Florsheim Drive, Libertyville, IL 60048, USA
| | - Anand Vora
- Illinois Bone and Joint Institute, LLC, 720 Florsheim Drive, Libertyville, IL 60048, USA
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Nikolopoulos D, Safos G, Moustakas K, Sergides N, Safos P, Siderakis A, Kalpaxis D, Moutsios-Rentzos A. Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420945330. [PMID: 35097403 PMCID: PMC8697201 DOI: 10.1177/2473011420945330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The os trigonum (OT)—the most common accessory bone of the foot—although usually asymptomatic, may cause posterior ankle impingement syndrome (PAIS), which may be a severely debilitating problem for recreational or competitive athletes. The aim of the present study was to evaluate effectiveness of posterior ankle arthroscopy and to assess the outcome in the treatment of PAIS secondary to OT impingement or OT fractures within a group of young athletes and their return to previous sports level. Methods: From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. All patients were diagnosed with PAIS due to OT pathology and were operated on endoscopically with resection of the OT. Pre- and postoperative clinical evaluation were performed at 3 months, 1 year, and 2 years based on visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the Foot & Ankle Disability Index (FADI) scores, in a follow-up of at least 2 years. Results: VAS score was significantly improved from an average of 7.5 (5-9) preoperatively to 1.9 (1-3) at 3 months postoperatively and to 0.6 (0-2) and 0.3 (0 -1) at 1 and 2 years postoperatively. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively (P < .001). Only 5 patients dropped to a lower activity level. There were 5 complications (4 transient). Conclusion: Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. Posterior ankle arthroscopy was an effective treatment and allowed for a prompt return to a high activity level of their athletic performance. Level of Evidence: Level IV, therapeutic study / retrospective case series.
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Affiliation(s)
- Dimitrios Nikolopoulos
- Central Clinic of Athens, Orthopaedic, Athens, Greece
- Orthopaedic Research Institute for Education and Training, Athens, Greece
| | - George Safos
- Central Clinic of Athens, Orthopaedic, Athens, Greece
- Orthopaedic Research Institute for Education and Training, Athens, Greece
| | - Konstantinos Moustakas
- Central Clinic of Athens, Orthopaedic, Athens, Greece
- Orthopaedic Research Institute for Education and Training, Athens, Greece
| | - Neoptolemos Sergides
- Central Clinic of Athens, Orthopaedic, Athens, Greece
- Orthopaedic Research Institute for Education and Training, Athens, Greece
| | - Petros Safos
- Orthopaedic Research Institute for Education and Training, Athens, Greece
- Ikaria General Hospital, Orthopaedic, Ikaria, Greece
| | | | - Dimitrios Kalpaxis
- Orthopaedic Research Institute for Education and Training, Athens, Greece
- Physiotherapist; Rehabilitation Center of Central Clinic of Athens, Greece
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Kushare I, Ditzler MG, Jadhav SP. Delayed diagnosis of posterior ankle impingement in pediatric and adolescent patients: does radiology play a role? Pediatr Radiol 2020; 50:216-223. [PMID: 31707447 DOI: 10.1007/s00247-019-04547-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/29/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Posterior ankle impingement syndrome (PAIS) results from the pinching of anatomical structures in the posterior part of the ankle. OBJECTIVE To identify the possible role of imaging in the delayed diagnosis of PAIS and identify key findings on imaging to suggest PAIS in pediatric and adolescent patients. MATERIALS AND METHODS Data were collected prospectively in patients younger than 18 years of age who underwent arthroscopy after being diagnosed with PAIS. Imaging was reviewed retrospectively by two radiologists, compared with findings in literature and an age-matched control group, and correlated with arthroscopic findings. Pre- and postsurgical Visual Analogue Scale (VAS) pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted. RESULTS Thirty-eight patients (20 females, 18 males), 51 ankles, with an average age of 12.9 years had an average 18-month delay in diagnosis. Twenty-seven of the 38 (73%) patients had previously seen multiple medical providers and were given multiple misdiagnoses. Radiographs were reported normal in 34/47 (72%) ankles. Thirty patients had magnetic resonance imaging (MRI) and findings included the presence of an os trigonum/Stieda process (94%) with associated osseous edema (69%), flexor hallucis longus (FHL) tenosynovitis (16%), and edema in Kager's fat pad (63%). Although individual findings were noted, the impression in the MRI reports in 16/32 (50%) did not mention PAIS as the likely diagnosis. There was a significant difference in the MRI findings of ankle impingement in the patient population when compared to the control group. Surgery was indicated after conservative treatment failed. All 51 ankles had a PAIS diagnosis confirmed during arthroscopy. At an average follow-up of 10.2 months, there was improvement of VAS pain (7.0 to 1.1) and AOFAS ankle-hindfoot scores (65.1 to 93.5). CONCLUSION PAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor. Increased awareness about this condition is needed among radiologists and physicians treating young athletes.
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Affiliation(s)
- Indranil Kushare
- Department of Orthopedics, Texas Children's Hospital, Houston, TX, USA
| | - Matthew G Ditzler
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Siddharth P Jadhav
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
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Kushare IV, Allahabadi S, McKay S. Posterior ankle impingement disguised as peroneal tendon subluxation in young athletes - a case report. J Clin Orthop Trauma 2020; 11:479-481. [PMID: 32405214 PMCID: PMC7211818 DOI: 10.1016/j.jcot.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/28/2023] Open
Abstract
Posterior ankle impingement is a cause of posterior ankle pain common in those who perform frequent plantarflexion activities. Three young patients presented with posterior ankle pain which was initially attributed to peroneal tendon subluxation. However, detailed physical exam and imaging confirmed the diagnosis of posterior ankle impingement as the actual cause of pain. The peroneal tendon subluxation was not causal but an unrelated co-incidental finding. After failed prolonged conservative management (rest, immobilization and physical therapy), the patients underwent posterior ankle arthroscopic debridement for the impingement resulting in return to prior sporting activity without limitation and no recurrence of pain at 19 months follow-up. Posterior ankle impingement diagnosis could be masked by co-incidental asymptomatic peroneal tendon subluxation in pediatric patients.
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Affiliation(s)
- Indranil V. Kushare
- Texas Children’s Hospital, Department of Orthopedic Surgery, Houston, TX, USA,Corresponding author. Orthopedic Surgery, Texas Children’s Hospital, 17580 I-45 South, 4th Floor, The Woodlands, Texas, 77384, USA.
| | - Sachin Allahabadi
- University of California at San Francisco, Department of Orthopedic Surgery, San Francisco, CA, USA
| | - Scott McKay
- Texas Children’s Hospital, Department of Orthopedic Surgery, Houston, TX, USA
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Kushare I, Kastan K, Allahabadi S. Posterior ankle impingement–an underdiagnosed cause of ankle pain in pediatric patients. World J Orthop 2019; 10:364-370. [PMID: 31750084 PMCID: PMC6854055 DOI: 10.5312/wjo.v10.i10.364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/08/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Posterior ankle impingement syndrome (PAIS) is a cause of ankle pain due to pinching of bony or soft tissue structures in the hindfoot. The diagnosis is primarily made based on detailed history and accurate clinical examination. The delay in its diagnosis has not yet been described in the pediatric and adolescent population.
AIM To identify and characterize misdiagnosed cases of PAIS in pediatric and adolescent patients.
METHODS This descriptive prospective study at a tertiary children’s hospital included patients ≤ 18 years who underwent posterior ankle arthroscopy after presenting with chronic posterior ankle pain after being diagnosed with PAIS. Collected data included: Demographics, prior diagnoses and treatments, providers seen, time to diagnosis from presentation, and prior imaging obtained. Visual Analogue Scale (VAS) for pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted at initial presentation and follow-up.
RESULTS 35 patients (46 ankles) with average age of 13 years had an average 19 mo (range 0-60 mo) delay in diagnosis from initial presentation. 25 (71%) patients had previously seen multiple medical providers and were given multiple other diagnoses. All 46 (100%) ankles had tenderness to palpation over the posterior ankle joint. Radiographs were reported normal in 31/42 (72%) exams. In 32 ankles who underwent MRI, the most common findings included os trigonum (47%)/Stieda process (47%). Conservative treatment had already been attempted in all patients. Ankle impingement pathology was confirmed during arthroscopy in 46 (100%) ankles. At an average follow-up of 13.1 mo, there was an improvement of VAS (pre-op 7.0 to post-op 1.2) and AOFAS scores (pre-op 65.1 to post-op 94).
CONCLUSION This is the first study which shows that PAIS is a clinically misdiagnosed cause of posterior ankle pain in pediatric and adolescent population; an increased awareness about this diagnosis is needed amongst providers treating young patients.
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Affiliation(s)
- Indranil Kushare
- Department of Orthopaedics, Texas Children’s hospital, The Woodlands, TX 77384, United States
| | - Kristen Kastan
- Department of Orthopaedics, Texas Children’s hospital, The Woodlands, TX 77384, United States
| | - Sachin Allahabadi
- Department of Orthopaedics, University of California, San Francisco, CA 94143, United States
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Fu X, Ma L, Zeng Y, He Q, Yu F, Ren L, Luo B, Fu S, Zhang L. Implications of Classification of Os Trigonum: A Study Based on Computed Tomography Three-Dimensional Imaging. Med Sci Monit 2019; 25:1423-1428. [PMID: 30794531 PMCID: PMC6396439 DOI: 10.12659/msm.914485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The os trigonum is an accessory bone that is not fully fused with the talus during secondary ossification, and is one of the risk factors of posterior malleolus impact syndrome. The purpose of this study was to classify the os trigonum and to guide the diagnosis and treatment of related clinical diseases. MATERIAL AND METHODS Ankle computed tomography (CT) scans of 586 Chinese patients between October 2014 and October 2018 were reviewed. CT images of 1011 ankle joints were reconstructed to evaluate the classification of the os trigonum and the measurement of anatomical parameters. RESULTS The incidences of os trigonum in 3 groups were determined as type I (1.9%), type II (10.5%), and type III (14.7%). The macro-axis of type II (0.89±0.31) cm was significantly larger than with type I (0.65±0.24 cm) and type III (0.74±0.23 cm) (p<0.05).The minor axis of similar of type I (0.41±0.23 cm) was significantly shorter than that of type II (0.58±0.32 cm) and type III (0.55±0.16 cm) (p<0.05).The distance from os trigonum to calcaneal tubercle was significantly different than that of type I (1.33±0.52 cm), type II (1.67±0.55 cm), and type III (1.84±0.45 cm) (p<0.05). CONCLUSIONS This study showed that os trigonum has a high incidence. Type I was the least common, the volume of type II was larger, and type III was more common. The anatomical parameters of each type may improve treatment of related diseases and the further development of ankle arthroscopic surgery.
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Affiliation(s)
- Xiaoyong Fu
- Department of Foot and Ankle Surgery, Guangzhou Orthopedic Hospital, Guangzhou, Guangdong, China (mainland)
| | - Li Ma
- School of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Yan Zeng
- Department of Nephrology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Qizhou He
- Department of Radiological, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Fei Yu
- Department of Radiological, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lin Ren
- Department of Radiological, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Bei Luo
- School of Basic Medical, Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shijie Fu
- Department of Orthopedic, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Department of Orthopedic, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland)
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17
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De Maeseneer M, Wuertzer S, de Mey J, Shahabpour M. The imaging findings of impingement syndromes of the lower limb. Clin Radiol 2017; 72:1014-1024. [DOI: 10.1016/j.crad.2017.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 05/22/2017] [Accepted: 07/04/2017] [Indexed: 12/28/2022]
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18
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Lee RP, Cheng SHS. Spontaneous resolution of posterior ankle joint loose bodies after total ankle replacement: A case report. Foot Ankle Surg 2017; 23:e13-e16. [PMID: 28578802 DOI: 10.1016/j.fas.2016.10.008] [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: 08/24/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 02/04/2023]
Abstract
Late stage ankle osteoarthritis often presents with debilitating pain. It is common to find osteophytes and loose body formation around the joint. Total ankle arthroplasty can preserve joint mobility and pain relieve for such patient. However, when trying to remove the osteophytes and loose bodies at the posterior ankle joint, there is risk of damaging posterior structures such as the neurovascular bundle during the procedure. We are presenting a case where the posterior loose bodies remained untouched during the operation, and patient showed spontaneous resolution of the lesions with time. Patient enjoyed good function outcome after the surgery.
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Affiliation(s)
- Raymond P Lee
- Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Hong Kong.
| | - Sally H S Cheng
- Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Hong Kong
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19
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20
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Lui TH. Decompression of Posterior Ankle Impingement With Concomitant Anterior Ankle Pathology by Posterior Ankle Arthroscopy in the Supine Position. Arthrosc Tech 2016; 5:e1191-e1196. [PMID: 28224076 PMCID: PMC5310188 DOI: 10.1016/j.eats.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023] Open
Abstract
Posterior ankle endoscopy is a safe and effective approach for treatment of posterior ankle impingement. This is usually performed with the patient in prone position. The purpose of this technical note is to describe an arthroscopic approach of decompression of posterior ankle impingement with the patient in supine position. This is indicated if there is posterior ankle impingement together with other ankle pathology requiring anterior ankle arthroscopy. This approach allows treatment of both anterior ankle and posterior ankle pathology with the patient in the supine position. Concomitant anterior ankle arthroscopy can be performed with the usual orientation without the need of change of patient's position.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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21
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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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