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Lyu P, Liu C, Li S. Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:411-418. [PMID: 38803280 PMCID: PMC11375498 DOI: 10.3724/zdxbyxb-2023-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. METHODS Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated, and Kappa consistency test was performed. RESULTS The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. However, the consistency between ultrasonography and arthroscopic results was poor (kappa=0.168). CONCLUSIONS Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures, but its specificity in diagnosing ATiFL-DF is poor. Therefore, ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.
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Affiliation(s)
- Panpan Lyu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
| | - Chao Liu
- Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
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2
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Li R, Li YQ, He KG, Gou XL, Zhang CK, Chen W, Wei FY, Yuan CS. Safety and clinical efficacy of double posterolateral coaxial portals for endoscopic management of posterior ankle impingement syndrome. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 37:8-13. [PMID: 38706659 PMCID: PMC11067006 DOI: 10.1016/j.asmart.2024.03.006] [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] [Received: 10/12/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background This study aims to analyze the safety and clinical efficacy of using double posterolateral coaxial portals for endoscopic treatment of posterior ankle impingement syndrome (PAIS), a procedure that has gained popularity in recent times. Methods Six fresh foot samples were randomly selected to measure the distances of two posterolateral portals to the sural nerve in different positions (plantar flexion 10°, dorsiflexion 30°, and plantar flexion 30°) for safety evaluation. A prospective analysis was conducted on the clinical efficacy of the operative approach for endoscopic management of posterior ankle impingement syndrome, including evaluation of effectiveness and complications. Results In this study, the mean distances of the first and second portals to the sural nerve were measured in different ankle positions. The distances were found to be 2.26 ± 0.22 cm and 1.59 ± 0.12 cm in the plantar flexion 10° position, 2.21 ± 0.21 cm and 1.55 ± 0.12 cm in the dorsiflexion 30° position, and 2.46 ± 0.29 cm and 1.73 ± 0.19 cm in the plantar flexion 30° position, demonstrating a significant safety margin from the nerve. A total of 38 patients underwent endoscopic treatment for posterior ankle impingement syndrome using double posterolateral coaxial portals between January 2012 and December 2017. This surgical approach provided access to the subtalar joint and posterior ankle region. The patients were followed up for an average of 38.2 months (24-72 months), with a satisfaction rate of 94.7%. There were no reported complications, and significant improvements were observed in both visual analogue scale (VAS) and The American Orthopedic Foot and Ankle Society Score (AOFAS) scores postoperatively. The VAS score decreased from 5.68 to 0.51 (P < 0.001), while the AOFAS score increased from 71.68 to 92.34 (P < 0.001), resulting in an excellent/good rate of 97.3%. Conclusion The use of double posterolateral coaxial portals in the treatment of posterior ankle impingement syndrome offers several advantages, including improved safety, reduced risk of nerve injury, enhanced visualization of the posterior ankle and subtalar joint, favorable clinical outcomes, and minimal complications.
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Affiliation(s)
- Rui Li
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Yuan-Qiang Li
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Kun-Gao He
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Xiao-Li Gou
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Chen-Ke Zhang
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Wan Chen
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Fang-Yuan Wei
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, 100029, China
| | - Cheng-Song Yuan
- Sports Medicine Center, Southwest Hospital, The Army Military Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
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Ogut E. The Stieda process of the talus: the anatomical knowledge and clinical significance of an overlooked protrusion. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:280. [DOI: https:/doi.org/10.1186/s42269-022-00968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/07/2022] [Indexed: 07/22/2023]
Abstract
Abstract
Background
The Stieda process (SP) is an extended lateral tubercle of the posterior process of the talus. Although there are different classifications for SP in the literature, it is essential to know the differential diagnosis of SP from fractures and accessory ossicles. This review aims to classify the SP and to guide the formation, prevalence, etiopathology, symptoms, differential diagnosis, and treatment.
Main body of the abstract
The authors conducted a literature review that lasted up to September 2022 and used the databases PubMed, Web of Science, and Google Scholar to explore the SP of the talus in all of its aspects. Out of 3802 publications, only 34 could be included, and most of them were studies on posterior ankle impingement syndrome (PAIS). The occurrence, prevalence, etiopathology, clinical significance, symptoms, differential diagnosis, and treatment methods of SP were investigated based on the literature. SP is formed by the fusion of a secondary ossification center at the posterolateral side of the talus with an incidence of 12–36.5%. It is frequently observed in males. It causes reduced plantar flexion, impairment in the inversion of the foot, pain, and swelling in the posterior ankle joint, PAIS, and SP fractures after trauma.
Short conclusion
SP can be diagnosed by lateral ankle radiography or MRI in patients complaining of PAIS. The initial treatment of the SP should include reducing inflammation, swelling, pain, and limiting activities. If neither modality affects the patient, surgical treatment will be performed, and SP will be resected until the impingement disappears.
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Subbannan SK, N C. A retrospective review of Tendoachilles repair in complete avulsion rupture with lengthening of Achilles tendon and suture anchor with immediate post operative neutral ankle immobilization. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01896-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hamoudi C, Doljencu A, Illes T. Avascular necrosis of the talus causing meniscoid lesions in the ankle joint: a case report. J Med Case Rep 2022; 16:83. [PMID: 35216628 PMCID: PMC8881834 DOI: 10.1186/s13256-022-03298-7] [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] [Received: 11/23/2020] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Meniscoid lesions have been reported in patients with chronic ankle injuries, especially in soccer athletes, and such lesions cause soft-tissue impingement and pain. To our knowledge, we are the first to report a meniscoid lesion in the ankle joint presenting as a long-term sequela of avascular necrosis of the talus that developed in childhood. Case presentation In this paper, we describe a 55-year-old Caucasian male patient who presented with a 1-year history of intermittent locking, “giving way,” weight-bearing pain, and swelling over the anterior aspect of the ankle joint. Imaging showed a rare case of avascular necrosis of the talus associated with an unstable plica-like lesion that was removed arthroscopically after unsuccessful conservative treatment. Conclusion We demonstrate that unstable meniscoid lesions of the ankle joint can be treated successfully with arthroscopic debridement. We obtained satisfactory short-term clinical results at the 2-year follow-up, even though advanced osteoarthritis was present.
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Affiliation(s)
- Ceyran Hamoudi
- Department of Orthopaedics, Brugmann University Hospital, Brussels, Belgium.
| | - Andrei Doljencu
- Department of Orthopaedics, Brugmann University Hospital, Brussels, Belgium
| | - Tamás Illes
- Department of Orthopaedics, Brugmann University Hospital, Brussels, Belgium
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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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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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8
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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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Endoscopic resection of a localized tenosynovial giant cell tumor causing posterior ankle impingement in a 15-year-old athlete: A case report. Jt Dis Relat Surg 2021; 32:234-238. [PMID: 33463443 PMCID: PMC8073462 DOI: 10.5606/ehc.2021.77699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a systematically benign but locally aggressive lesion arising from the synovium, tendon sheath or joint bursae. Even in athletes, soft tissue tumors may be the underlying reason or a component of posterior ankle impingement, although the most common mechanism is forceful and repetitive plantar flexion. In this article, we present a case of localized TGCT in a 15-year-old female patient presenting with symptoms of posterior ankle impingement. The preferred technique for treatment was complete local resection via posterior ankle endoscopy. The patient returned to sports at three months and no recurrence was observed on the last follow-up at the first postoperative year. Although rare, soft tissue tumors should be taken into consideration in posterior ankle impingement in athletes. Such benign soft tissue tumors in the posterior ankle can be treated safely and effectively via two-portal posterior endoscopic approach.
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10
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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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11
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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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12
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Abstract
BACKGROUND The os trigonum is known as one of the main causes of posterior ankle impingement. In the literature, a wide variation of occurrence has been reported. METHODS All foot and/or ankle computed tomography (CT) scans made between January 2012 and December 2013 were reviewed. CT images were assessed, blinded for patient characteristics, for the presence of an os trigonum, size of the os trigonum, and type of os trigonum. In addition, the shape of the lateral tubercle of the posterior talar process was assessed. RESULTS A total of 628 patients (1256 ankles) were included. In 32.5% of the patients of the cohort, an os trigonum was present. In 14.3% of these patients, it was present bilaterally. In a subgroup of patients without posterior ankle impingement the prevalence was 30.3%. Of the nonaffected ankles, an os trigonum was present in 23.7%. Patients with posterior ankle impingement were more likely to have an os trigonum (adjusted odds ratio [OR], 1.86). Afro-Caribbean/Surinamese/Central African origin was associated with a lower rate of occurrence of os trigonum (adjusted OR 0.43). In the ankles without an os trigonum, an enlarged lateral tubercle of the posterior talar process was found in 34.9% and 36.5% of the ankles. CONCLUSION This study showed that os trigonum is a common accessory bone. With a prevalence of 30.3% in a population of patients with CT imaging of both ankles and 23.7% of the nonaffected ankles, the os trigonum is more common than previously reported. Patients with posterior ankle impingement complaints had a higher prevalence of an os trigonum. In one-third of the patients without an os trigonum, there was an enlarged lateral tubercle of the posterior talar process. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ruben Zwiers
- 1 Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS) Amsterdam, the Netherlands
| | - Thomas P A Baltes
- 1 Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS) Amsterdam, the Netherlands
| | - Kim T M Opdam
- 1 Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS) Amsterdam, the Netherlands
| | - Johannes I Wiegerinck
- 1 Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS) Amsterdam, the Netherlands
| | - C Niek van Dijk
- 1 Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS) Amsterdam, the Netherlands
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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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14
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Abstract
Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. It usually occurs following a sprain injury or repetitive microtrauma causing haemorrhage, synovial hyperplasia, and abnormal soft tissue interposition within the joint. MR imaging is particularly valuable in being able to detect not only the soft tissue and osseous abnormalities involved in these syndromes, but also a wide variety of other potential causes of ankle pain and instability that also may need to be addressed clinically.
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15
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Kudaş S, Dönmez G, Işık Ç, Çelebi M, Çay N, Bozkurt M. Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:649-654. [PMID: 27919560 PMCID: PMC6197591 DOI: 10.1016/j.aott.2016.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/27/2016] [Accepted: 03/12/2016] [Indexed: 12/12/2022]
Abstract
Objective To describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players. Material and methods A case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures. Results The complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24–42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42–56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19–77 months). Conclusion Non-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails. Level of evidence Level IV, Therapeutic study
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16
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Walker R, Kunkle WA, Carreira DS. Arthroscopic Approach to Osteochondral Defects, Impingement, and Instability. Clin Sports Med 2015; 34:689-703. [PMID: 26409590 DOI: 10.1016/j.csm.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteochondral defects, impingement, and instability of the ankle are common injuries in athletes. In this article, we review these diagnoses and their treatment options, with a focus on arthroscopic approaches. The treatment options continue to evolve, supported by innovation and outcome studies. In this article, we describe the advantages and disadvantages of both open and arthroscopic treatments using published evidence.
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Affiliation(s)
- Roger Walker
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA
| | - William Aaron Kunkle
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA
| | - Dominic S Carreira
- Sports Medicine and Orthopedics, Broward Health Medical Center, 1601 South Andrews Avenue, 2nd Floor, Fort Lauderdale, FL 33316, USA.
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Pruna R, Ribas J, Montoro JB, Artells R. The impact of single nucleotide polymorphisms on patterns of non-contact musculoskeletal soft tissue injuries in a football player population according to ethnicity. Med Clin (Barc) 2015; 144:105-10. [DOI: 10.1016/j.medcli.2013.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 01/13/2023]
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18
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Spratford W, Hicks A. Increased delivery stride length places greater loads on the ankle joint in elite male cricket fast bowlers. J Sports Sci 2014; 32:1101-9. [PMID: 24576107 DOI: 10.1080/02640414.2014.886130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate the effect stride length has on ankle biomechanics of the leading leg with reference to the potential risk of injury in cricket fast bowlers. Ankle joint kinematic and kinetic data were collected from 51 male fast bowlers during the stance phase of the final delivery stride. The bowling cohort comprised national under-19, first class and international-level athletes. Bowlers were placed into either Short, Average or Long groups based on final stride length, allowing statistical differences to be measured. A multivariate analysis of variance with a Bonferroni post-hoc correction (α = 0.05) revealed significant differences between peak plantarflexion angles (Short-Long P = 0.005, Average and Long P = 0.04) and negative joint work (Average-Long P = 0.026). This study highlighted that during fast bowling the ankle joint of the leading leg experiences high forces under wide ranges of movement. As stride length increases, greater amounts of negative work and plantarflexion are experienced. These increases place greater loads on the ankle joint and move the foot into positions that make it more susceptible to injuries such as posterior impingement syndrome.
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Affiliation(s)
- Wayne Spratford
- a Sport Science Sport Medicine Unit , Cricket Australia Centre of Excellence , Brisbane , Australia
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19
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Sung KH, Chung CY, Lee KM, Lee SY, Park MS. Anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in residual poliomyelitis. Foot Ankle Int 2013; 34:1233-7. [PMID: 23620500 DOI: 10.1177/1071100713488092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. METHODS Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. RESULTS Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). CONCLUSIONS Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ki Hyuk Sung
- Kwandong University Myongji Hospital, Kyungki, Goyang, Korea
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Pruna R, Artells R, Ribas J, Montoro B, Cos F, Muñoz C, Rodas G, Maffulli N. Single nucleotide polymorphisms associated with non-contact soft tissue injuries in elite professional soccer players: influence on degree of injury and recovery time. BMC Musculoskelet Disord 2013; 14:221. [PMID: 23890452 PMCID: PMC3726514 DOI: 10.1186/1471-2474-14-221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The biological mechanisms involved in non-contact musculoskeletal soft tissue injuries (NCMSTI) are poorly understood. Genetic risk factors may be associated with susceptibility to injuries, and may exert marked influence on recovery times. METHODS Data on type and degree of injury and recovery time were collected in 73 male professional soccer players (43 White, 11 Black Africans and 19 Hispanics) who suffered total of 242 injuries (203 muscle, 24 ligament, and 15 tendon injuries). One single nucleotide polymorphism (SNPs) in the following genes were analyzed: Elastin (ELN); Titin (TTN); SRY-related HMG-box (SOX15); Insulin-like growth factor 2 (IGF2); Chemokine, CC motif, ligand 2 (CCL2); Collagen type 1 alpha 1(COL1A1); Collagen type 5 alpha 1 (COL5A1), and Tenascin C (TNC). RESULTS There was evidence of a statistically significant association between the degree of injury and the IGF2 genotype (P = 0.034). In addition, there was evidence of a statistically significant association between the degree of muscle injury and CCL2 (P = 0.026) Finally, there was evidence of a statistically significant association between ELN and degree of injury (p = 0.009) and recovery time (P = 0.043). There was no evidence of a statistically significant association between any of the genes studied and degree of injury or recovery time for tendon injuries. CONCLUSION SNPs in the IGF2, CCL2, and ELN genes may be associated to the degree and recovery time of NCMSTI.
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Waldén M, Hägglund M, Ekstrand J. Time-trends and circumstances surrounding ankle injuries in men's professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47:748-53. [DOI: 10.1136/bjsports-2013-092223] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fantino O, Borne J, Bordet B. Conflicts, snapping and instability of the tendons. Pictorial essay. J Ultrasound 2012; 15:42-9. [PMID: 23396604 DOI: 10.1016/j.jus.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Conflicts, snapping and instability of the tendons are common, and ultrasound (US) is the method of choice for evidencing these conditions thanks to the possibility to perform dynamic maneuvers during imaging studies. A conflict can occur between a tendon and a bone structure, other tendons, the retinacula or pulleys. Snapping can occur due to instability caused by rupture of the retinaculum, conflict between a thickened retinaculum and a bone prominence or due to an abnormal position of the tendon. Instability can occur due to insufficient ability of the retinaculum to keep the tendons in the bone groove or its failure to hold the tendons applied to the bone.The technique for evidencing conflicts, snapping and instability of the tendons is very demanding because it requires a thorough knowledge of the US appearance and dynamic maneuvers. However, at the present time US examination completed with dynamic maneuvers is the investigation of choice for evidencing these disorders and providing the clinicians with the necessary information.
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Affiliation(s)
- Olivier Fantino
- Medical Imaging du Parc, Orthopedic Clinic du Parc, Lyon, France
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