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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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Ráfare AL, Rodriguez BC, de Souza Ribeiro BF, Fernandes RMP, Babinski MA, Pires LAS. Os trigonum: a discussion of its role in posterior ankle impingement syndrome and a meta-analysis of its prevalence. Surg Radiol Anat 2024; 46:1137-1143. [PMID: 38780789 DOI: 10.1007/s00276-024-03389-8] [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] [Received: 09/25/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone. METHODS A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using "os trigonum" as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant. RESULTS 249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7-14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies. CONCLUSION Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.
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Affiliation(s)
- André Limongi Ráfare
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil
| | - Beatriz Correa Rodriguez
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil
| | - Bruna Fernanda de Souza Ribeiro
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil
| | - Rodrigo Mota Pacheco Fernandes
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil
| | - Marcio Antonio Babinski
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil
| | - Lucas Alves Sarmento Pires
- Morphology Department, Biomedical Institute, Universidade Federal Fluminense, Alameda Barros Terra, 57 - São Domingos, Niterói, Rio de Janeiro, 24020-150, Brasil.
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Anastasio AT, Kutzer K, Giambelluca L, Strasser NL, Amendola A. Posterior Ankle and Hindfoot Arthroscopy: A Contemporary Review. Foot Ankle Int 2024; 45:86-98. [PMID: 37905829 DOI: 10.1177/10711007231204882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham NC, USA
| | | | - Lacey Giambelluca
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham NC, USA
| | | | - Annunziato Amendola
- Virginia Flowers Baker Distinguished Professor of Orthopaedic Surgery
- Sports Medicine, Division Chief, Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA
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Theodoulou MH, Ravine M. Posterior Ankle Impingement. Clin Podiatr Med Surg 2023; 40:413-424. [PMID: 37236679 DOI: 10.1016/j.cpm.2022.12.002] [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
This article is devoted to managing posterior ankle impingement syndrome and its management using endoscopic to arthroscopic surgical instrumentation. The authors explore the critical anatomy, pathogenesis, and clinical examination. Operative techniques, including the approach, and instrumentation used, are outlined. The postoperative protocol is discussed. Finally, a literature review is provided, which also defines known complications.
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Affiliation(s)
- Michael H Theodoulou
- Podiatric Surgery, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, 1439 Cambridge Street, Cambridge, MA 02139, USA.
| | - Madison Ravine
- Cambridge Health Alliance Podiatric Medicine & Surgery Residency Program, 1439 Cambridge Street, Cambridge, MA 02139, USA
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Abstract
Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced hyperplantarflexion. Posterior ankle impingement results from chronic, repetitive trauma to the posterior ankle capsule, flexor hallucis longus tendon, and/or os trigonum. It is important to perform a thorough workup by isolating and testing the posterior compartment muscles and obtaining proper imaging with radiographs to identify any osseous abnormalities and MRI to evaluate the soft tissue structures. Nonsurgical treatment includes activity modification, physical therapy, and steroid injections.
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Affiliation(s)
- Megan A Ishibashi
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA.
| | - Craig E Krcal
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 3600 Broadway, Oakland, CA 94611, USA
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Rui Xiang T, Zhen Ning Y, Oon Thien Kevin K. Two-Year Outcomes of Posterior Ankle Arthroscopy: A Case Series. Foot Ankle Spec 2022; 15:556-562. [PMID: 33435736 DOI: 10.1177/1938640020985822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the outcomes and complications after posterior ankle arthroscopy for the treatment of posterior ankle impingement syndrome, in a local population with a single surgeon series. Two-portal posterior ankle or hindfoot arthroscopy is an alternative option to open surgery in cases of posterior ankle impingement, that showed similar results but with less morbidity and faster recovery. There has been increasing interest in minimally invasive surgical techniques. Indications include extra- and intra-articular conditions and range from bony, cartilaginous to soft tissue pathology. Posterior ankle arthroscopy has been shown to be a good option in cases that are refractory to a period of conservative therapy. Posterior ankle arthroscopy also has known complications of sural nerve damage laterally and neurovascular bundle injury medially and also a steep learning curve that has been studied in the context of os trigonum excision. There have been few or no studies on the local Singaporean population and this article seeks to describe the various indications, results, and complications in the local Singaporean population by a single surgeon.Levels of Evidence: Level IV: Case series.
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Affiliation(s)
| | - Yeo Zhen Ning
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lai JHC, Fung NPY, Yeung STW, Siu RWH, Pak NK, Surgenor B, Yung PSH, Ling SKK. Comparison of Dance-Related Foot and Ankle Injuries Among Pre-Professional Ballet, Contemporary, and Chinese Dancers. J Dance Med Sci 2022; 26:134-142. [PMID: 35287790 DOI: 10.12678/1089-313x.061522f] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Foot and ankle injuries have been noted as the most common in dancers. However, the variability of injury epidemiology across different dance genres has not been clearly evaluated. Herein, this study aimed to evaluate the prevalence and incidence of foot and ankle problems in pre-professional ballet, contemporary, and Chinese dancers.<br/> Methods: Participants (N = 54) were recruited from a local dance institution that offered a formal undergraduate dance program. Demographic characteristics and specifics of foot and ankle pain during dancing were collected through an online self-reporting survey from September 2018 to June 2019. Descriptive statistical analyses, including injury incidence and risk rates, were conducted.<br/> Results: The overall response rate was 69.3%, with a total of 88 subjects eligible for analysis of which the results from 54 subjects were ultimately analyzed. The incidence of foot and ankle pain during the academic year of 2018 to 2019 was highest in contemporary dancers (0.38 per 1,000 dance hours) when compared to that of ballet (0.32 per 1,000 dance hours) and Chinese dancers (0.22 per 1,000 dance hours). Prevalence of foot and ankle pain within the same year was 84% in ballet dancers, 79% in Chinese dancers, and 70% in contemporary dancers. Ballet dancers were six times more likely to suffer from pain in the Achilles region than Chinese and contemporary dancers (p < 0.01). Chinese dancers were found to experience more forefoot and midfoot problems compared to ballet and contemporary dancers (p < 0.05).<br/> Conclusion: This study illustrated that foot and ankle pain is highly prevalent among pre-profes- sional dancers. Ballet was associated with the highest prevalence of foot-ankle pain while contemporary dance was associated with the highest incidence. There were significant differences of foot and ankle pain among dance genres and anatomical subregions, which suggests a need for targeted genre-specific injury prevention programs in hopes of preventing potentially career-ending injuries in dancers.
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Affiliation(s)
- Jojo H C Lai
- Faculty of Medicine, The Chinese University of Hong Kong; Hong Kong Association of Dance Medicine and Science
| | - Naomi P Y Fung
- Faculty of Medicine, The Chinese University of Hong Kong
| | | | - Ronald W H Siu
- Faculty of Medicine, The Chinese University of Hong Kong
| | | | - Brenton Surgenor
- Hong Kong Association of Dance Medicine and Science; School of Dance, Hong Kong Academy for Performing Arts
| | | | - Samuel K K Ling
- Faculty of Medicine, The Chinese University of Hong Kong; Hong Kong Association of Dance Medicine and Science;,
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Talar Body Fracture Treated by Hindfoot Endoscopic Reduction and Internal Fixation. Case Rep Orthop 2022; 2022:6183508. [PMID: 35615458 PMCID: PMC9126715 DOI: 10.1155/2022/6183508] [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: 08/30/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background A talar body fracture is relatively rare. Surgical treatment for the fracture is generally indicated for the displaced fracture types and traditionally performed via open approaches. However, open approaches may not be able to achieve adequate exposure of the talus body owing to the difficulty in achieving reduction and fixation of the fracture. In this case report, we describe a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. Case report. A 39-year-old man who was a carpenter complained of right hindfoot pain after he fell from a stepladder during work. Although plain radiographs of the right ankle showed no abnormal findings, noncontrast computed tomography demonstrated a fracture line from the lateral side of the posterior lateral process to the medial side of the talus body. In addition, the fracture line extended to the posterior ankle and subtalar joints, and the bone fragment was slightly displaced. We diagnosed him with the talar body fracture and performed operative treatments using hindfoot endoscopic reduction and internal fixation. At 14 weeks after the operation, he was able to return to work at the preinjury activity level without dysfunction of the ankle nor complications. Conclusion We reported a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. In this case, the hindfoot endoscopic technique provided visualization of the fracture site with less invasiveness and increased safety, which enabled proper reduction and internal fixation of the fracture site. Therefore, the patient was able to return to work at the preinjury activity level at 14 weeks after surgery without dysfunction of the ankle nor complications. This surgical technique may be a useful option for the talar body fracture.
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Baillie P, Mayes S, Lam J, Ferrar K, Cook J. Associations between clinical and imaging findings in posterior ankle impingement syndrome: a systematic review. Acta Radiol 2022; 63:652-657. [PMID: 33874783 DOI: 10.1177/02841851211008389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. The relationship between clinical and imaging findings in PAIS has not been established. PURPOSE To investigate the relationship between clinical and imaging features in PAIS by reviewing the literature comparing symptomatic patients to asymptomatic controls. MATERIAL AND METHODS A systematic literature search was performed to identify all English-language articles that compared imaging features in patients diagnosed with PAIS to imaging in an asymptomatic control group. RESULTS A total of 8394 articles were evaluated by title and abstract, and 156 articles were read in full text. No articles compared imaging findings to an asymptomatic control group, thus no articles met the inclusion criteria. CONCLUSION This systematic review found no published research that compared the imaging findings of people diagnosed with PAIS to asymptomatic people. Until this information is available, imaging features in people with posterior ankle impingement should be interpreted with caution.
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Affiliation(s)
- Peta Baillie
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Susan Mayes
- The Australian Ballet, South Melbourne, VIC, Australia
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - Jason Lam
- The Australian Ballet, South Melbourne, VIC, Australia
| | - Katia Ferrar
- The Australian Ballet, South Melbourne, VIC, Australia
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - Jill Cook
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
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Mercer NP, Samsonov AP, Dankert JF, Gianakos AL, Stornebrink T, Delmonte RJ, Kerkhoffs GMJ, Kennedy JG. Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement. Arthrosc Sports Med Rehabil 2022; 4:e629-e638. [PMID: 35494297 PMCID: PMC9042901 DOI: 10.1016/j.asmr.2021.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS). Methods A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. Results Ten patients (4 male and 6 female) with a mean age of 41.9 ± 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 ± 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 ± 10.3 to 80.3 ± 12.6), pain (69.3 ± 11.0 to 78.2 ± 13.9), activities of daily living (61.7 ± 8.8 to 77.93 ± 11.4), sports activities (55.6 ± 12.7 to 76.0 ± 13.6), and quality of life (46.6 ± 9.2 to 71.1 ± 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 ± 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 ± 1.5 (range, 5-10). Conclusions The current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again. Level of Evidence IV, therapeutic case series.
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Chen JS, Kaplan DJ, Colasanti CA, Dankert JF, Kanakamedala A, Hurley ET, Mercer NP, Stone JW, Kennedy JG. Posterior Hindfoot Needle Endoscopy in the Office Setting. Arthrosc Tech 2022; 11:e273-e278. [PMID: 35256963 PMCID: PMC8897487 DOI: 10.1016/j.eats.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023] Open
Abstract
Posterior hindfoot disorders encompass a spectrum of bony, cartilaginous, and soft-tissue pathology. Traditional open surgical techniques have been increasingly replaced by less-invasive arthroscopic and endoscopic approaches. Recent innovations such as the advent of the needle arthroscope continue to push the boundary of minimally invasive interventions. This Technical Note highlights our technique for posterior hindfoot needle endoscopy for common posterior hindfoot pathologies in the wide-awake office setting, including indications, advantages, and technical pearls.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John G. Kennedy
- Address correspondence to John G. Kennedy, M.D., NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY 10010.
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3-T MRI of the Ankle Tendons and Ligaments. Clin Sports Med 2021; 40:731-754. [PMID: 34509208 DOI: 10.1016/j.csm.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.
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Ling CT, Walsh SJ. Outcomes of a 2-Portal Endoscopic Technique for Osseous Lesions Resulting in Posterior Ankle Impingement Syndrome. J Foot Ankle Surg 2021; 59:938-941. [PMID: 32376077 DOI: 10.1053/j.jfas.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/10/2019] [Accepted: 03/20/2020] [Indexed: 02/03/2023]
Abstract
Posterior ankle impingement syndrome is common in sporting populations and encompasses a range of disorders that cause posterior ankle pain during maximal forced plantarflexion. The aim of this study was to evaluate the short- and medium- to long-term outcomes of 2-portal endoscopic surgery for osseous lesions causing posterior ankle impingement syndrome. This was a retrospective case series analysis of all patients who underwent 2-portal endoscopic surgery at a single institution between 2005 and 2016. Visual analogue scales and selected components of the Short Form of the Revised Foot Function Index were used to assess ankle function, with the median follow-up time being 4.8 years. Of the 52 patients, 49 (94%) were able to return to their previous sport/physical activity, with the mean time taken being 5.8 months. At the completion of follow-up, the mean pain score during exercise had improved from 7.5 to 0.9 points. The mean work and sporting function scores also improved, from 5.9 to 9.6 points and 2.9 to 8.8 points, respectively. The mean score of the Short Form of the Revised Foot Function Index also improved by 77.7 points, from 84.4 to 6.7 at the completion of follow-up. There were no postoperative infections or any other major complications. This study provides strong supporting evidence for the use of hindfoot endoscopy in the treatment of posterior ankle impingement syndrome in athletes.
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Affiliation(s)
- Christopher T Ling
- Orthopedic Resident, Starship Children's Hospital, Grafton, Auckland, New Zealand
| | - Stewart J Walsh
- Orthopedic Surgeon, UniSports Sports Medicine, St Johns, Auckland, New Zealand.
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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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Abstract
INTRODUCTION Ankle arthroscopy has come a long way since it was thought, it is not feasible because of tight joint and anatomical characteristics of ankle joint. The same anatomical features like capsular attachment and safe accessory portals are used to access the whole joint even with a rigid arthroscope. Ankle distraction method was routinely used to access the anterior ankle. However, nowadays, anterior arthroscopy is done in dorsiflexion as this increases the anterior ankle joint volume, and thereby easy access to various anatomical structures. On the other hand, intermittent traction is used to access the posterior ankle. Initially used as a diagnostic tool, ankle arthroscopy is now used extensively as a therapeutic and reconstruction tool. New evidence is published for all inside ligament reconstructions, effective management of impingement syndromes, and osteochondral lesions. The indications are being extended to fracture management and arthrodesis. METHODOLOGY This narrative review was performed following a literature search in the Pubmed database and Medline using the following keywords: ankle arthroscopy, portals, ankle OCD, functional outcome. Related articles were then reviewed. CONCLUSION Complications rate is reduced with a better understanding of the relative anatomy of surrounding neurovascular structures and tendons with regard to the position of ankle joint. This review on ankle arthroscopy focuses on anatomy, indications, and complications. Ankle arthroscopy is a safe and elegant tool as any other joint arthroscopy.
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Szaro P, Ghali Gataa K, Polaczek M. Ligaments of the os trigonum: an anatomical study. Surg Radiol Anat 2021; 43:1083-1090. [PMID: 33554290 PMCID: PMC8273053 DOI: 10.1007/s00276-021-02694-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study was to examine the ligaments of the os trigonum. METHODS The ankle joint magnetic resonance imaging (MRI) of 104 patients with the os trigonum (experimental group) and 104 patients without the os trigonum (control group) were re-reviewed. The connections of the os trigonum and posterior talofibular ligament (PTFL), the fibulotalocalcaneal ligament (FTCL), the paratenon of the Achilles tendon, the posterior talocalcaneal ligament (PTCL), the osteofibrous tunnel of the flexor hallucis longus (OF-FHL) and the flexor retinaculum (FR) were studied. RESULTS The os trigonum is connected to structures. The posterior part of the PTFL inserted on the os trigonum in 85.6% of patients, whereas in all patients in the control group, the posterior part of the PTFL inserted on the posterior talar process (p < 0.05). The connection of the PTCL was seen in 94.2% of patients in the experimental group, while it was seen in 90.4% of patients in the control group (p > 0.05). The connection to the FTCL in the experimental group was 89.4%, while in the control group, it was 91.3% (p > 0.05). The communication with the paratenon was seen more often in the control group compared to that in the experimental group (31.7% vs. 63.8%, p < 0.001). The FTCL was prolonged medially into the FR in 85.6% of patients in the experimental group and in 87.5% of patients in the control group (p > 0.05). The flexor hallucis longus (FHL) run at the level of articulation between the os trigonum 63.5% and the posterior process of the talus 25% and less often on the os trigonum 11.5%. CONCLUSION The os trigonum is connected with all posterior ankle structures and more connections than previously reported.
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Affiliation(s)
- Paweł Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Göteborgsvägen 31, 431 80, Gothenburg, Sweden
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Bezuglov E, Khaitin V, Lazarev A, Brodskaia A, Lyubushkina A, Kubacheva K, Waśkiewicz Z, Petrov A, Maffulli N. Asymptomatic Foot and Ankle Abnormalities in Elite Professional Soccer Players. Orthop J Sports Med 2021; 9:2325967120979994. [PMID: 33614799 PMCID: PMC7869170 DOI: 10.1177/2325967120979994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Professional soccer players are often evaluated with asymptomatic lesions of the ankle and foot, and such abnormalities may eventually become clinically relevant. Purpose To ascertain the prevalence of foot and ankle abnormalities in elite professional adult soccer players. Study Design Case series; Level of evidence, 4. Methods Professional adult male elite soccer players (n = 37) underwent magnetic resonance imaging (MRI) scans of both their feet and ankles. All competed for their respective national junior or adult soccer teams. MRI scans were performed with 1.5-T scanners and analyzed independently by 2 experienced radiologists. Results The MRI scans of 86.5% of the players showed degenerative joint disease (DJD) in at least 1 of the joints of the foot and ankle. Articular cartilage lesions in the joints of the foot and ankle were evident in 42% of the scans. Of all lesions, 17% were grade 3 or 4 (Noyes and Stabler classification) cartilage lesions and accompanied by subchondral bone marrow edema. The greater the age, weight, and height of the players, the greater was the odds ratio of DJD of the ankle joint. Synovitis in at least 1 of the joints of the foot was detected in 64% of the MRI scans. Leg dominance significantly correlated with bone marrow edema of the talus. Conclusion Elite professional soccer players are often evaluated with a high prevalence of asymptomatic osteochondral lesions with subchondral bone marrow edema in the foot and ankle. These osteochondral lesions may remain asymptomatic or, with the continuing high-intensity stresses that modern professional soccer demands of its athletes, may evolve and cause foot and ankle pain. It is unclear whether and which interventions can be implemented to prevent the occurrence of these abnormalities in the first place.
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Affiliation(s)
- Eduard Bezuglov
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Federal Research and Clinical Center of Sports Medicine and Rehabilitation of Federal Medical Biological Agency, Moscow, Russia.,High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia
| | - Vladimir Khaitin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.,Football Club Zenit St. Petersburg, St. Petersburg, Russia
| | - Artemii Lazarev
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia
| | - Alesia Brodskaia
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Anastasiya Lyubushkina
- High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia.,Smart Recovery Clinic, Moscow, Russia
| | - Kamila Kubacheva
- St. Petersburg State Public Institution City Hospital No. 40, St. Petersburg, Russia
| | - Zbigniew Waśkiewicz
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Arseniy Petrov
- Georg-August University of Göttingen, Göttingen, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
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Currey J, Sheng D, Neph Speciale A, Cinquini C, Cuza J, Waite BL. Performing Arts Medicine. Phys Med Rehabil Clin N Am 2020; 31:609-632. [PMID: 32981582 DOI: 10.1016/j.pmr.2020.08.001] [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] [Indexed: 12/26/2022]
Abstract
Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care.
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Affiliation(s)
- Jovauna Currey
- Department of Sports and Physical Medicine, Kaiser Permanente, The Permanente Medical Group, 3975 Old Redwood Highway, MOB 5, Suite 152, Santa Rosa, CA 95403, USA. https://twitter.com/jcurreymd
| | - Dana Sheng
- Department of Physical Medicine and Rehabilitation, UC Davis, UC Davis Health, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
| | - Alyssa Neph Speciale
- Department of Physical Medicine and Rehabilitation, UC Davis, UC Davis Health, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
| | - Camilla Cinquini
- Kaiser Permanente Rehabilitation, The Permanente Medical Group, 3975 Old Redwood Highway, MOB 5, Suite 154, Santa Rosa, CA 95403, USA
| | - Jorge Cuza
- Department of Physical Medicine and Rehabilitation, UC Davis, UC Davis Health, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
| | - Brandee L Waite
- Department of Physical Medicine and Rehabilitation, UC Davis School of Medicine, UC Davis Sports Medicine, 3301 C Street, Suite 1600, Sacramento, CA 95816, USA.
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Walsh KP, Durante EC, Moser BR, Coetzee JC, Stone McGaver R. Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series. Orthop J Sports Med 2020; 8:2325967120938767. [PMID: 32743013 PMCID: PMC7376299 DOI: 10.1177/2325967120938767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Management of ankle pain in dancers can be challenging because of the repetitive stress and complex demands placed on this region. Despite the prevalence of ankle injuries in this population, literature on surgical outcomes and return to dance is limited. Purpose To retrospectively evaluate the efficacy and functional outcomes after surgical excision of a symptomatic os trigonum in dancers. Study Design Case series; Level of evidence, 4. Methods Between June 2006 and June 2016, a total of 44 dancers underwent surgical excision of a symptomatic os trigonum at a single institution and by a single surgeon. All patients presented with symptoms of posterior ankle impingement syndrome and subsequently failed nonsurgical treatment. Clinical analysis was conducted using various pre- and postoperative patient-reported outcome questionnaires, including the Veterans RAND 12-Item Health Survey (VR-12), Foot Function Index-Revised (FFI-R), and visual analog scale (VAS) for pain, as well as subjective patient satisfaction. Results A total of 44 patients (54 ankles; mean age, 18.2 years) were retrospectively evaluated at a mean follow-up of 33.4 months. The VR-12 Physical Health score improved from a mean score of 37.8 ± 11.9 to 51.2 ± 10.5 (P < .001). The cumulative FFI-R score improved from 46.45 ± 13.8 to 31.2 ± 9.7 (P = .044), with the subcategory of "activity limitation" representing the highest-scoring FFI-R subcategory at 65.28 ± 13.4 preoperatively and improving to 34.47 ± 12.4 at follow-up (P < .001). The mean VAS score for subjective pain improved significantly from 5.39 ± 2.84 to 1.73 ± 2.10 (P < .00044). Conclusion Overall, the findings of the present study demonstrate that dancers of varying style and level improved significantly according to various clinical measures. Patients included in this study reported that they returned to their previous level of dance upon completion of physical therapy and maintained thriving postoperative careers, which for several meant dancing at the professional level.
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Affiliation(s)
- Keifer P Walsh
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
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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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Hickey B, Dalmau-Pastor M, Karlsson J, Calder J. Hindfoot endoscopic release of the posterior ankle capsuloligamentous structures improves ankle dorsiflexion range, function and pain in patients with painful limitation of ankle dorsiflexion. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the effect of arthroscopic release of the posterior capsuloligamentous structures on ankle dorsiflexion and function in patients with painful limitation of ankle dorsiflexion.MethodsA prospective consecutive case series of 13 adult patients with painful limitation of ankle dorsiflexion were included. None had clinically relevant gastrocnemius, soleus or Achilles contracture. Patients with anterior bony impingement or ankle degeneration on CT scan were excluded. All patients underwent combined anterior and posterior ankle arthroscopies with resection of posterior capsuloligamentous structures and the posterior fibulotalocalcaneal ligament. Ankle range of motion was assessed 2 years postoperatively. Foot and Ankle Outcome Scores (FAOS) were used to assess functional outcome.ResultsThe median patient age at surgery was 26 years (range 19–44). At 2 years postsurgery, the ankle dorsiflexion range had increased by 15 degrees (range 0–25, p<0.0001). FAOSs completed at a median of 44 months postsurgery (range 26–72) significantly improved. Median improvements were 19 points for pain (range 6–67, p=0.0004), 14 points for symptoms (range 0–36, p=0.0005), 15 points for activities of daily living (range 6–35, p<0.0001), 45 points for sport (range 20–55, p<0.0001) and 50 points for quality of life (range 13–62, p<0.0001).ConclusionsHindfoot endoscopic release of the posterior ankle structures, including the posterior fibulotalocalcaneal ligament, is an effective technique for improving ankle dorsiflexion range in patients with painful limitation of ankle dorsiflexion.Level of evidenceIV.
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Carreira DS, Garden SR, Ueland T. Operative Approaches to Ankle and Hindfoot Arthroscopy. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419894968. [PMID: 35097358 PMCID: PMC8564949 DOI: 10.1177/2473011419894968] [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: 11/16/2022] Open
Abstract
The role of arthroscopy in the management of ankle and hindfoot pathology management has increased greatly in recent years with the potential for lower complication rates, faster recovery, improved access, and improved outcomes when compared to open techniques. Procedural variations exist as techniques aim to optimize lesion access, decrease operative time, and improve patient safety. Our goal is to summarize the described approaches and patient positionings common in minimally invasive arthroscopic surgery for anterior, lateral, and posterior ankle pathologies. A survey of pathology organized by arthroscopic approach and a review of recent advances in concomitant lesion management may be useful when planning arthroscopic foot and ankle surgery. LEVEL OF EVIDENCE Level V, expert opinion.
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23
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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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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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