SLR - September 2022 - Melissa Lipari, DPM R3
Reference: Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-Office Needle Arthroscopy for the Treatment of Anterior Ankle Impingement Yields High Patient Satisfaction With High Rates of Return to Work and Sport. Arthroscopy. 2022 Apr;38(4):1302-1311.Level of Evidence: IV, Case series study.
Reviewed by: Melissa Lipari, DPM R3
Residency Program: Legacy Health, Portland OR
Podiatric Relevance: This study demonstrates the excellent patient outcomes following the relatively new concept of in-office needle arthroscopy (IONA). This literature suggests that more orthopedic and podiatric surgeons may be offering this service to patients in near the future.
Methods: Thirty-one (31) patients over 18 years old were prospectively collected. They were diagnosed with anterior ankle impingement using both X-ray and MRI. Each patient underwent IONA with a minimum of 12 month follow-up. Under local anesthesia only, the Arthrex 1.9 millimeters NanoScope was utilized through standard anterior medial and lateral portals for the treatment of soft tissue impingement and debridement of tibia and/or talar exostosis. Several clinical outcomes were evaluated both pre-operatively and at final follow-up: Foot and Ankle Outcome Scores (FAOS) and Patient Reported Outcomes Measurement Information System (PROMIS). A 5-point Likert patient satisfaction score was also evaluated at final follow-up.
Results:
Percentage of patients achieving minimal clinically important difference:
- FAOS Symptoms: 77 percent (24/31)
- FAOS Pain: 84 percent (26/31)
- FAOS ADL: 61 percent (19/31)
- FAOS Sports: 74 percent (23/31)
- FAOS Quality of Life: 75 percent (23/31)
- PROMIS Pain Interference: 65 percent (20/31)
- PROMIS Pain Intensity: 42 percent (13/31)
Likert Satisfaction Score:
- Very satisfied: 67 percent
- Satisfied: 29 percent
- Neutral: 0 percent
- Unsatisfied: 4 percent (1 patient)
- Very unsatisfied: 0 percent
Return to Work/Sports
- 100 percent of patients returned to work on average return time of 1.98 days
- 96 percent of patients returned to their previous sports on average return time of 3.9 weeks
Conclusions: The IONA procedure provides significant pain reduction with excellent patient satisfaction outcomes and a low complication rate. Allowing patients to visualize their treatment directly on the arthroscopy monitor while getting narrative real-time feedback from their surgeon increases transparency, patient-provider trust, and patient satisfaction. This transparency can reduce perioperative patient anxiety. The majority of complications during arthroscopy are due to portal site nerve injury, which is theoretically reduced with smaller incisions and instrumentation. Smaller incisions also reduce the area in which bacteria can enter the body and create infections, as they noted 0 percent infection rate in this study. Smaller instrumentation also reduces the risk of severe iatrogenic cartilage damage during insertion, which can help providers feel more comfortable and safe utilizing these tools. Another important benefit of arthroscopy is improved diagnostic accuracy over MRI. This study reported an increase in sensitivity of 17 percent when utilizing IONA compared to MRI, with the diagnosis of loose bodies to be even more discrepant. This is important to remember for providers, as loose bodies left in a joint can create accelerated chondral damage. IONA provides both the patient and surgeon an intermediate treatment option between conservative methods and surgical intervention which is likely to have cost savings compared to intra-operative arthroscopy due to lack of need for anesthesia, operating room staff, and equipment. As most surgeons today have their operative schedules booked out far in advance, this also offers a faster way for patients to get the diagnostic and therapeutic treatment they need in a timely manner.