SLR - May 2010 - Alex Scholl

Return to Training and Playing After Posterior Ankle Arthroscopy for Posterior Impingement in Elite Professional Soccer

Reference: 
Calder, J, Sexton, S., Pearce, C. (2010). Return to Training and Playing After Posterior Ankle Arthroscopy for Posterior Impingement in Elite Professional Soccer.  The American Journal of Sports Medicine, 38:1

Scientific Literature Review 

Reviewed by:  Alex Scholl, DPM
Residency Program:  St John Hospital and Medical Center; Detroit, MI

Podiatric Relevance:
This study provides an alternative and minimally-invasive approach to treat posterior ankle impingement syndrome (PAIS) in elite athletes with the added benefit of an early return to activities.

Methods:
The study design incorporated a case review series of 28 players over a 5-year period.  Each player had a team doctor or physiotherapist who performed the initial evaluation.    The players were diagnosed radiographically (radiographs with MRI and/or CT) and clinically with posterior ankle impingement syndrome (PAIS). Those players who failed to respond to conservative treatment  underwent posterior ankle arthroscopy for soft tissue or osseous posterior impingement.  The number of preoperative injections was noted along with the length of symptoms prior to surgery.  Finally, the time to training and match play was assessed.

Results:
The average follow up period was 23 months, with one player lost to follow-up.  The average length of symptoms with failed conservative treatment before surgery was 8 months.  Each player had an at least one image guided injection (local anesthetic with steroid) prior to surgery.   2-portal endoscopic approach was used to access the posterior ankle joint.  Five had soft tissue impingement with debridement and release of the flexor hallucis longus, 13 had a symptomatic os trigonum, and 9 had removal of a bony avulsion fragment.  Average time to training was 34 days, and return to playing was 41 days.  There was a correlation to the return to training/playing when compared to length of preoperative symptoms.   No major complications were noted.

Conclusions:
Posterior ankle arthroscopy is an effective alternative to traditional open treatment of PAIS.

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