SLR - June 2016 - Arian Ashkan

Arthroscopic Debridement of the Ankle for Mild to Moderate Osteoarthritis: A Midterm Follow-up Study in Former Professional Soccer Players

Reference: Osti L, Del Buono A, Maffulli N. Arthroscopic Debridement of the Ankle for Mild to Moderate Osteoarthritis: A Midterm Follow-up Study in Former Professional Soccer Players. J Orthop Surg Res. 2016 Mar 30;11:37.

Scientific Literature Review


Reviewed By: Arian Ashkan, DPM
Residency Program: Wyckoff Height Medical Center

Podiatric Relevance: Ankle arthritis is a common condition seen in athletes, especially in soccer players. Ankle injuries may lead to a condition known as “footballer’s ankle,” which is consistent with the presence of a bone spur, fibrous tissue impingement and ligament instability. Ankle arthroscopy is indicated for early stages of the condition. However, there is an absence of guidelines for treatment of this condition and the effect of ankle arthroscopy in patients with osteoarthritis remains unclear. This study reports the outcome of arthroscopic treatment for mild to moderate osteoarthritis and anterior impingement in soccer players.

Methods:
A retrospective study was done in 15 male athlete patients who underwent ankle arthroscopy for mild to moderate ankle arthritis during time period 2001 to 2010. All ankle arthroscopy procedures were performed at a single institution. Inclusion criteria consisted of ankle arthritis with narrowing but not absent joint space, anterior impingement, limited motion, loose bodies, pain unresponsive to conservative treatment, inability to practice loading sports, and discomfort in daily activities. The exclusion criteria consisted of complete obliteration of the ankle space, reflex sympathetic dystrophy, presence of bone marrow edema, posterior impingement, history of ankle fracture, cavus and varus deformity and body mass index >30. The first author performed all the surgeries and after surgery all patients started a homogenous rehabilitation with active and passive range of motions and followed by partial weightbearing with crutches six-weeks post-operative. After completing this protocol, all patients returned to sport six months after surgery. At follow-up, the AOFAS and Kaikkonen scoring systems were used to analyze the outcome. The system described by Krips et al. was also used to classify the ankle arthritis. The Kolmogrov Smirnov test and the Wilcoxon signed ranked test and Pearson chi-square tests were used to compare the preoperative and postoperative. 

Results: All patients returned with an average final follow-up of 7.4 years and the average age at surgery of 42 years. The operation was done an average of eight months after onset of symptoms. The AOFAS significantly improved from average preoperative score of 48 to 86 at the last evaluation post-operative. The AOFAS scores were excellent in 47 percent, good in 27 percent, fair in 20 percent and poor in 6 percent of patients. The Kaikkonen was significantly improved from 43 to 85 on average at the last evaluations. The VAS values also improved from 7.1 preoperatively to 2.9 post operatively. At final evaluations 53 percent of patients practiced high-impact sport activities and 40 percent practiced non-weightbearing sports, all on average of twice weekly. One patient (7 percent) did not participate in any sport activities. Three patients evolved to grade 3 osteoarthritis and from them two returned to low-impact non-weightbearing sports and one patient stopped practicing sports activity. There were no surgical complications reported.

Conclusions: In conclusion, this study suggests that arthroscopic surgery for former professional athletes with mild to moderate ankle arthritis can be considered as a safe and significantly effective with more than 70 percent of patients having excellent or good outcomes. Professional athletes with ankle injuries and arthritis may benefit from ankle arthroscopy surgery and most may return to their activities safely and in a relatively short period of time. 

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