Summary

This study demonstrates that in-office needle arthroscopy (IONA) treatment of posterior ankle impingement results in significant pain reduction, a low complication rate and excellent patient reported outcomes with high rates of return to work/sport.

Abstract

The hypothesis was that IONA in the treatment of posterior ankle impingement would provide the patient with a unique experience of their pathology and facilitate their rapid recovery through an awareness of their own condition, and that using IONA would accelerate recovery to sports-specific activities compared to the literature using standard arthroscopic procedures.

Methods

This was a retrospective cohort study investigating patients who underwent IONA for posterior ankle impingement between 2019 and 2020. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: The Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A five-point Likert scale regarding patient satisfaction was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.

Results

Ten patients were included in this study, which included 4 males and 6 females with a mean age of 41.9 ± 15.5 years (range, 24-66 years) and mean body mass index (BMI) of 28.3 ± 6.3 kg/m2 (range, 17.1 – 39.9). The mean follow-up time was 13.3 ± 2.9 months (range, 11-17 months). The mean postoperative FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life were 80.3 ± 12.6, 78.2 ± 13.9, 77.93 ± 11.4, 76.0 ± 13.6 and 71.1 ± 12.1 at final follow-up respectively. The mean PROMIS Pain Intensity T-score significantly decreased from 57.5 ± 8.4 preoperatively to 49.5 ± 5.5 at final follow-up (p<0.001). The mean PROMIS Pain Interference T-score decreased from 69.0 ± 5.8 preoperatively to 63.1 ± 5.8 at final follow-up (p<0.001). There were 7 patients who participated in sports activity prior to IONA-arthroscopy procedure. Of those, 7 patients (100%) returned to their sports activities. The median time to return to sports was 4.1 weeks (range, 1 to 14 weeks). The median time to return to work was 3.4 days ± 5.3. Patients reported an overall positive experience with a mean rating scale of 9.5 ± 1.5 (range, 5 to 10). Nine patients (90%) reported the highest rating (10/10) for overall positive experience and felt that seeing their procedure in real time aided in their understanding of their underlying pathology. Lastly, 10 patients (100%) expressed willingness to undergo the same procedure again.

Conclusion

The current study demonstrates that IONA treatment of posterior ankle impingement results in significant pain reduction, a low complication rate and excellent patient reported outcomes with high rates of return to work/sport. Additionally, IONA for posterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.