Title: Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain
Authors: Takao M, Uchio Y, Naito K, Fukazawa I, Ochi M
Source: American Journal of Sports Medicine 2005; 33(5): 686-692
PODIATRIC RELEVANCE:
The ankle sprain is one of the most common traumatic disorders encountered by Podiatric physicians. The majority of these patients heal without consequence through non-operative measures, but a minority of patients have residual pain and functional disability that require further work-up. The normal sequential diagnostic and clinical evaluation involves the physical exam, standard radiography, stress radiography and magnetic resonance imaging. This article examines the idea that although many causes of residual ankle pain can be determined with standard diagnostic tools, there are some entities that can only be detected with direct arthroscopic evaluation.
METHODS:
A cohort, diagnostic, double-blind study of 98 patients with residual ankle pain lasting more than two months after suffering a sprain were initially evaluated in this study. Stress radiography was performed to evaluate subtalar joint instability. Seventy two patients who did not have STJ instability were included in the study. All subjects underwent a physical exam (including anterior drawer test), normal radiographic examinations, stress radiography, and an MRI. The results were analyzed by three examiners. An ankle arthroscopic exam was performed by a single assessor on all 72 patients. The arthroscopic results were compared and contrasted against the non-invasive diagnostic findings in a double-blind manner.
RESULTS:
The pre-operative diagnoses included 39 patients (54.2%) with ATFL injury, 14 (19.4%) with distal tibiofibular injury, 21 (29.1%) had osteochondral lesions, 13 (15.9%) has symptomatic os subfibulare, three (3.7%) had anterior impingement exostoses, and 16 (22.2%) cases in which the cause of the disability could not be determined. Ankle arthroscopic findings found the same results using the alternative means of diagnosis, but additionally found three distal tibiofibular ligament injuries, eight osteochondral lesions, and three cases of impingement by abnormally thickened fibrous bands. There were two cases of residual ankle pain in which the cause of the symptoms could not be determined by arthroscopy.
COMMENTS:
There are many causes of residual ankle pain and disability that can follow a sprain. In cases where the cause of symptoms can not be determined by traditional diagnostic means, including MRI, exploratory ankle arthroscopy should be advocated.
It is also important to note that only grade 3 and 4 osteochondral lesions were able to be observed on MRI with 3 mm slices. Direct ankle arthroscopic examination was able to detect grade 1 and 2 lesions. This article demonstrates that ankle arthroscopy is an important diagnostic tool in cases to find the cause of residual ankle pain undetected by conventional diagnostic modalities.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.