SLR - July 2015 - Tyler Silverman

Arthroscopic Treatment for Anterior Ankle Impingement: A Systematic Review of the Current Literature

Reference: Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN. Arthroscopic Treatment for Anterior Ankle Impingement: A Systematic Review of the Current Literature. Arthroscopy. 2015 Mar 19.

Scientific Literature Review

Reviewed By: Tyler Silverman, DPM
Residency Program: Cambridge Health Alliance

Podiatric Relevance: Anterior ankle impingement is a pathology for which patients may present to a podiatric physician.  Many times, anterior ankle impingement does not respond to conservative treatment.  Therefore, the podiatric physician is faced with deciding on the best operative intervention.  Surgeons can choose between arthroscopic or open technique for debridement of the anterior ankle.

Methods: A systematic review of Medline, Embase (classic), and CINAHL was performed.  Search terms were: (ankle AND impingement) OR (ankle AND impingement AND syndrome) OR ((talar OR talus) AND compres*) AND ((arthrosc*) OR (surgery OR procedures) OR (treatment)).  In addition a search of Cochrane was performed using the term “impingement.”  The studies were independently reviewed by two reviewers.  Twenty articles were included in the review.

Results: The results reported include patient satisfaction; 74% to 100% of the patients were satisfied with the outcome.  The summed complication rate was 5.1%.  The AOFAS scores increased from a mean of 83.5 to 92.  The rate of patient returning to sports ranged from 24% to 100%, and the rate at which patients returned to full activity ranged from 81% to 100%.  There was also an increase in angle range of motion post-operatively.  Finally, 94.3% to 97.5% of patients said they would undergo the same procedure again.

Conclusions: There were generally good outcomes with arthroscopic treatment of anterior ankle impingement.  It was noted that there is significant variability among the studies and outcomes measures.  There was limited data comparing soft tissue and bony impingement.  There were better outcomes when treating anterolateral impingement compared to anteromedial impingement.  Finally, there was limited data on other associated pathologies and their effect on outcomes.  More studies are needed to evaluate the different types of impingement.

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