SLR - July 2015 - Jeff Weber

Simultaneous Ankle Arthroscopy and Hindfoot Endoscopy for Combined Anterior and Posterior Ankle Impingement Syndrome in Professional Athletes

Reference: Miyamoto W., Takao M., Matsui K, Matsushita T.  Simultaneous ankle arthroscopy and hindfoot endoscopy for combined anterior and posterior ankle impingement syndrome in professional athletes. Journal of Orthopaedic Science. 2015 Mar 24.

Scientific Literature Review

Reviewed By: Jeff Weber, DPM
Residency Program: Detroit Medical Center

Podiatric Relevance: Athletes are a unique subset of the patient population that require special attention due to the high physical demand of the sport in which they participate coupled with high expectations that are placed upon them by team owners, coaches, parents, and themselves. Return to sport can be paramount to one’s career in the case of the professional athlete, but is often times equally important to the overall quality of life for recreational athletes.  Failed conservative care of ankle impingement syndrome leads to open as well as arthroscopic treatment measures. The authors of this article conclude that arthroscopy can be used to significantly improve pain and functional levels in athletes with anterior and posterior ankle impingement syndrome  (AAIS and PAIS respectively) and help them return to their sport.

Methods: This is a retrospective study of 9 (8 men, 1 woman) professional athletes and a total of 12 ankles with combined anterior and posterior ankle impingement syndrome who were surgically treated with arthroscopy and endoscopy. Age range was 19-34 with median age of 25.  All patients were followed up at a minimum of 24 months.  None had undergone previous surgery. All patients underwent radiographic examination, CT, and MRI evaluation to assess all osseous and soft tissue structures. PAIS was diagnosed with these measures coupled with an ultrasound guided anesthetic injection.  Outcome measures included pre and postoperative AOFAS scores, VAS scores, and degree of active ankle joint range of motion. Statistical analysis of the outcome measures was performed using the Wilcoxon signed rank test.  Active range of motion began POD 1, passive ROM 2 weeks postop, and full weightbearing POD 2.

Results: Nine patients, 12 ankles underwent arthroscopy and endoscopy for AAIS and PAIS.  Median follow up was 40 months (range 24-49 months).  Median AOFAS scores improved significantly (p < .01) from 63 preoperatively to 82 postoperatively.  The median VAS score improved significantly from 85 (scale 0 to 100) preoperatively to 8 postoperatively (p < .01).  The median active ankle plantar flexion and dorsiflexion improved significantly from 40 degrees and 10 degrees preoperatively to 50 degrees and 15 degrees postoperatively (P < .01 and .05 respectively).  All patients returned to sport at a median of 12 weeks postoperatively.

Conclusion: All 9 patients in this study desired return to activity as soon as possible after surgery. Pathology other than AAIS and PAIS, such as lateral ankle instability and osteochondral lesions of the talus were found in several athletes, but were left untreated as surgical intervention for them would have required a prolonged recovery course and because the primary symptomatology was anterior and posterior ankle pain consistent with AAIS and PAIS.   Despite these other pathologies not being addressed, significant improvement was seen in VAS and AOFAS scores as well as active ankle range of motion postoperatively compared to preoperatively.  Previous studies have shown faster recovery time with arthroscopy vs. open surgery. This study supports that simultaneous arthroscopic and endoscopic treatment for AAIS and PAIS is effective for professional athletes who desire to return to their sport as quickly as possible.

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