Summary

Several studies showed satisfactory short-term results after arthroscopic resection of the bone spur, considering arthroscopic resection as the gold standard. However, the results tend to deteriorate with time. Based on these results, we propose not only the resection of bone spur syndrome exostosis, but the joint treatment of its associated causes as long-term prognostic factors.

Abstract

Introduction

Anterior impeachment of the ankle is characterized by the presence of a bone spur on the anterior aspects of the tibia and/or talus, limiting motion and causing pain in forced dorsal flexion. Pes cavus and instability showed a statistical tendency to be a negative prognostic factor in the long term for isolated anterior impingement resection. Several studies showed satisfactory short-term results after arthroscopic resection of the bone spur considering arthroscopic resection as the Gold Standard. However, the results tend to deteriorate with time. The aim of the following study is to evaluate whether patients treated by anterior ankle impeachment have good long-term results if associated with treatment of the probable etiology of the exostosis.

Methods

This is a retrospective observational study, in which 33 patients, operated between 2016 and 2021, were included. All patients with a history of anterior ankle pain and mobility limitation, with a history of more than 6 months of orthopedic treatment without improvement were included. Clinical, radiological and tomographic examinations were performed before surgery to objectify the presence of anterior ankle exostosis, and
also to check if they have associated mechanical instability of the ankle or associated pathologies such as pes cavus or varus rearfoot. Patients who had only the impeachment exostosis resected without an added procedure were excluded.The evaluation was performed by an independent observer who evaluated the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle questionnaire and the evaluation of the radiographic incidence of Saltzman and lateral ankle preoperatively and postoperatively in all patients during follow-ups.

Results

Thirty-three patients were operated (27 men-6 women), the location of the exostosis was identified (central 9 - lateral 7 -. medial 5 - mirror 12), the medial age was 20 (RIQ 29-49) The average follow-up was 45.5 months. The Aofas score increased from 61.18 to 90.82 which gave a significant p (< 0.0001). All patients reported pain improvement and were satisfied with the intervention. None of them developed the previous frictional syndrome again until the end of the study. There were no complications, only one superficial wound infection. No patient required reoperation.

Conclusion

All patients underwent resection of the anterior exostosis, associated procedure was performed, depending on the cause of the impingement, being a arthroscopic all-inside repair of lateral ankle ligaments for ankle instability. In other patients the added procedure was a percutaneous sliding calcaneal and Dwyer's osteotomy. Arthroscopic treatment provides good results in general, for the treatment of anterior ankle
impingement, but the presence of instability or varus hindfoot as causes are relevant as long-term prognostic factors. Based on these results, it is proposed not only to resect the exostosis of the bone impingement syndrome but to treat its associated causes together.