Technique and results of arthroscopic treatment of posterior ankle impingement

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Abstract

Background

The aim of this study was to investigate the outcome after arthroscopic procedures for treatment of posterior ankle impingement.

Methods

From June 2006 to April 2009 36 patients were treated by hindfoot arthroscopy. Indication was posterior ankle impingement due to symptomatic os trigonum or osteophytes. Pain on the VAS was evaluated pre- and postoperatively. Minimum follow-up was 6 months.

Results

30 patients were available for follow-up. Follow-up averaged 9.7 months (range 6–14 months). Pain measured on the VAS improved significantly from 7.2 points to 1.3 points. One superficial (3.3%) and one deep wound infection (3.3%) occurred, 6.6% of our patients complained about impaired sensitivity of the sural nerve, and 6.6% required resurgery.

Conclusions

Hindfoot arthroscopy is an elegant surgical technique in treatment of posterior ankle impingement. The minimally invasive procedure allows for low complication rates.

Introduction

Hindfoot arthroscopy is an operative technique that was developed in the late 1990s. In 1997 Bazar and Ferkel reported on results of arthroscopic plantar fascia release [3] and in 1997 and 1998 van Dijk and Kort published the arthroscopic approach to the tibial posterior tendon and peroneal tendon sheath, the so-called “tendoscopy” [27], [28]. In 1999 Lombardi et al. presented a new technique of arthroscopic excision of a symptomatic os trigonum [12]. In the European region the surgical technique of hindfoot arthroscopy has been mainly propagated and advanced by van Dijk from Amsterdam, Netherlands [4], [20], [21], [22], [24], [25], [26], [27], [28], [29], [30]. However, the number of publications and case reports recently published on this subject show the increase of interest in this minimally invasive surgical method [5], [6], [8], [9], [10], [13], [14], [16], [17], [19], [20], [29], [32], [33].

The arthroscopic technique is suitable for treatment of pathologies of the posterior aspect of the ankle joint and the subtalar joint, e.g. osteophytes or ossicles causing a posterior impingement with limited and painful plantarflexion (Fig. 1). These osseous structures can be resected easily by arthroscopic method [18], [21], [24], [25], [29], [32]. The arthroscopic technique allows for a minimally invasive removal of a symptomatic os trigonum as often seen in ballet dancers [8], [9], [12], [16] or painful pseudarthrosis after fracture of the posterior talar process and also enables the surgeon to debride the flexor hallucis longus tendon in case of tendinitis [10], [12]. Besides the mentioned extraarticular entities intraarticular chondral lesions in the posterior part of the joint can be treated by microfracturing under arthroscopic control. The posterior arthroscopic exposure can also be used to perform subtalar arthrodesis [2], [5], [7], [11], [23].

The aim of this study was to show that posterior ankle impingement can be sufficiently treated by arthroscopic methods.

Section snippets

Materials and methods

From June 2006 to April 2009 we treated 36 patients by hindfoot arthroscopy due to posterior ankle pain. During follow-up the visual analog scale (VAS) for pain were evaluated and postoperative complications was monitored. A minimum follow-up range 6 months was mandatory. A paired t-test was performed to evaluate the results.

Results

From June 2006 to April 2009 we treated 36 patients by hindfoot arthroscopy for posterior ankle impingement according to the above mentioned technique (12 female:24 male). 30 patients (11 female:19 male) were available for follow-up. Average age was 46 years (range 14–71 years). Follow-up averaged 9.7 months (range 6–14 months) whereby a minimum follow-up of 6 months was mandatory. VAS (visual analog scale) improved significantly from 7.2 points preoperatively to 1.3 points postoperatively (p < 

Discussion

The os trigonum is a small accessory bone located at the posterior ankle joint which is present in about 5–15% of normal feet. An os trigonum occurs when the ossification nucleus of the posterior talar process does not fuse with the rest of the talus during growth. Normally, this accessory bone does not cause any symptoms. In some people, however, this small bone can become pinched in the space behind the ankle in plantarflexion of the ankle and can cause pain known as posterior ankle

Conclusions

Hindfoot arthroscopy presents an efficient and minimally invasive method in treatment of posterior pathologies of the ankle joint with good results and the advantage of low complication rates and a better cosmetic appearance.

Conflict of interest statement

No conflict of interest.

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