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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [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: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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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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Dujela MD, Houng BE. Arthroscopic Treatment of Anterior Ankle Impingement. Clin Podiatr Med Surg 2023; 40:397-411. [PMID: 37236678 DOI: 10.1016/j.cpm.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Arthroscopic reduction of tibiotalar osteophytes results in good to excellent results in the vast majority of patients. Pain is primarily due to synovial hypertrophy and anterior tibiotalar entrapment associated with the osteophytes. Osteophytes may be due to repetitive trauma such as sports, or associated with subtle or overt ankle instability. A minimally invasive approach results in rapid recovery and less risk than open interventions. In cases where anterior osteophytes have coexisting ankle instability and in many cases ancillary procedures such as ankle stabilization are performed.
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Affiliation(s)
- Michael D Dujela
- Advanced Reconstructive Foot and Ankle Surgery, Washington Orthopaedic Center, 1900 Cooks Hill Road, Centralia, WA 98532, USA.
| | - Brian E Houng
- Advanced Reconstructive Foot and Ankle Surgery, Washington Orthopaedic Center, 1900 Cooks Hill Road, Centralia, WA 98532, USA
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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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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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Impingement syndromes of the ankle and hindfoot. Pediatr Radiol 2019; 49:1691-1701. [PMID: 31686174 DOI: 10.1007/s00247-019-04459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/02/2019] [Accepted: 06/18/2019] [Indexed: 10/25/2022]
Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft-tissue or osseous abnormality affecting the tibiotalar joint or extraarticular soft tissues. Impingement can be associated with a prior single traumatic event or repetitive microtrauma, often in an adolescent with anatomical predisposition. Impingement syndromes at the tibiotalar joint can be subdivided into anterior, anterolateral, anteromedial, posterior or posteromedial. Extraarticular impingement can consist of talocalcaneal or subfibular impingement. Impingement syndromes are just one possible etiology of persistent ankle pain, and although the diagnosis is often made or suspected clinically, the radiologist might be the first person to raise the possibility of the diagnosis or be called upon to provide support for the clinically suspected diagnosis. In this article I review the etiology, imaging findings and current treatment associated with these conditions.
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ACR Appropriateness Criteria ® Chronic Ankle Pain. J Am Coll Radiol 2018; 15:S26-S38. [PMID: 29724425 DOI: 10.1016/j.jacr.2018.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/26/2022]
Abstract
Chronic ankle pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic ankle pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Morvan A, Klouche S, Thes A, Hardy P, Bauer T. Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:713-719. [DOI: 10.1007/s00590-017-2116-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/17/2017] [Indexed: 11/28/2022]
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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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12
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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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Walls RJ, Ross KA, Fraser EJ, Hodgkins CW, Smyth NA, Egan CJ, Calder J, Kennedy JG. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop 2016; 7:8-19. [PMID: 26807351 PMCID: PMC4716575 DOI: 10.5312/wjo.v7.i1.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/06/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.
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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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Kim HK, Jeon JY, Dong Q, Kim HN, Park YW. Ankle arthroscopy in a hanging position combined with hindfoot endoscopy for the treatment of concurrent anterior and posterior impingement syndrome of the ankle. J Foot Ankle Surg 2013; 52:704-9. [PMID: 24160718 DOI: 10.1053/j.jfas.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to evaluate the results of arthroscopic and endoscopic treatment of concurrent anterior and posterior ankle impingement with the patient in a prone position. From May 2009 to September 2010, 22 patients with simultaneously combined anterior and posterior ankle impingements underwent ankle arthroscopy in a prone position. Noninvasive ankle distraction was achieved by hanging the affected ankle on a shoulder-holding traction frame, followed by hindfoot endoscopy. The mean age at surgery was 22.6 (range 20 to 46) years. The mean follow-up duration was 15.4 (range 12 to 29) months. The American Orthopaedic Foot and Ankle Society scores and Foot Function Index were checked preoperatively and at the final follow-up visit. The mean American Orthopaedic Foot and Ankle Society score increased from 62.6 preoperatively to 86.0 at the final follow-up visit (p < .05). The Foot Function Index improved from 45.8 to 17.2 (p < .05). Of the 22 patients, 18 were very satisfied or satisfied with the results, 2 rated their results as fair, and 2 were dissatisfied. No complications related to ankle distraction in a hanging position occurred. Ankle arthroscopy with the patient in a prone position with the ankle hung on a shoulder-holding traction frame combined with hindfoot endoscopy provided a useful method for treating anterior and posterior ankle impingement that does not require changing the patient's position from supine to prone.
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Affiliation(s)
- Hyong Kyun Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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16
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Spiga S, Vinci V, Tack S, Macarini L, Rossi M, Coppolino F, Boi C, Genovese EA. Diagnostic imaging of ankle impingement syndromes in athletes. Musculoskelet Surg 2013; 97 Suppl 2:S145-S153. [PMID: 23949936 DOI: 10.1007/s12306-013-0280-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
The chronic ankle pain is a very frequent clinical problem, which is often characterized by a painful mechanical limitation of full-range ankle movement. A large amount of causes are involved in its pathogenesis, but the most common forms are secondary to an osseous or soft tissue abnormality. Especially for professional athletes, impingement lesions are the most important causes of chronic pain; however, this symptomatology can also affect ordinary people, mostly in those who work in environments that cause severe mechanical stress on the joints. This group of pathologies is characterized by a joint conflict secondary to an abnormal contact among bone surfaces or between bones and soft tissues. Diagnosis is mainly clinic and secondly supported by imaging in order to localize the critical area of impingement and determine the organic cause responsible for the joint conflict. Treatments for different forms of impingement are similar. Usually, the first step is a conservative approach (rest, physiotherapy, ankle bracing, shoe modification and local injection of corticosteroids), and only in case of unsuccessful response, the second step is the operative treatment with open and arthroscopic techniques. The aim of the study is to describe different MR imaging patterns, comparing our data with those reported in the literature, in order to identify the best accurate diagnostic protocol.
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Affiliation(s)
- S Spiga
- Department of Radiology, University of Cagliari, Cagliari, Italy
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17
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Affiliation(s)
- Randall C Marx
- The San Antonio Orthopedic Group, 2829 Babcock Road, Suite #700, San Antonio, TX 78229, USA
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18
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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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