SLR - July 2022 - Andrew Bloom, DPM
Reference: Zwiers R, Miedema T, Wiegerinck JI, Blankevoort L, van Dijk CN. Open Versus Endoscopic Surgical Treatment of Posterior Ankle Impingement: A Meta-analysis. The American Journal of Sports Medicine. 2022;50(2):563-575. doi:10.1177/03635465211004977Scientific Literature Review
Reviewed By: Andrew Bloom, DPM
Residency Program: University Hospital
Podiatric Relevance: Posterior Ankle impingement is more likely to occur in active patients whose main movement is repetitive plantarflexion and is characterized by posterior ankle pain during hyperplantarflexion of the ankle. Pain can be caused by osseous or soft tissue impingement and the surgical treatment consists of resection of either the osseous or soft tissue causing factor. Open surgical techniques work historically well but some advantages have been reported with newer arthroscopic techniques.
Methods: A meta-analysis was performed in which the authors search MEDLINE, EMBASE, COCHRANE and CINAHL databases for articles relating to the topic. Studies were included in the study if they reported outcomes of surgical treatment for posterior ankle impingement surgery and included greater than 10 patients. Studies were excluded if more than one pathology was corrected or only pediatric studies. Thirty-two (32) studies were included in this article. Patient AOFAS scores were the primary outcome measure, but the authors also looked at time to return to full activity, patient satisfaction rates and complication rates.
Results: No significant difference was noted by the authors when comparing open versus arthroscopic surgical techniques for AOFAS score, patient satisfaction or time to full activity. When studies of poor quality were excluded, there was a significant difference for both minor and total complications, favoring the arthroscopic group.
Conclusions: The authors of this study found no significant difference in the open versus arthroscopic repair of posterior ankle impingement when looking at AOFAS scores, patient satisfaction or time to full activity. They did find an increase in complication rates with open repair versus arthroscopic repair.