2025 ISAKOS Biennial Congress ePoster
The Effectiveness of Hindfoot Endoscopic Surgery for Posterior Ankle Impingement Syndrome due To Os Trigonum in High-level Athletes
Yuta Matsumae, MD JAPAN
Shota Morimoto, MD, PhD, Nishinomiya, Hyogo JAPAN
Hideyuki Sawada, MD, Nishinomiya, Hyogo JAPAN
Masashi Nakamura, MD, Nishinomiya, Hyogo JAPAN
Tomoya Iseki, MD, PhD, Nishinomiya, Hyogo JAPAN
Hyogo Medical University, Nishinomiya, Hyogo, JAPAN
FDA Status Not Applicable
Summary
Hindfoot endoscopic surgery present an effective and safe treatment for PAIS due to os trigonum in high-level athletes.
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Abstract
Background
Posterior ankle impingement syndrome (PAIS) is a condition in which hindfoot pain occurs due to plantar flexion of the ankle. The causes of PAIS are generally divided into osseous lesions and soft tissue lesions, especially in os trigonum is well known as one of osseous lesions. Although conservative treatment is generally recommended as the initial treatment for PAIS, surgical treatment is indicated when 3-months conservative treatment is ineffective. Hindfoot endoscopic surgery is the most common surgical procedure for PAIS.
Purpose
To review our experiences with hindfoot endoscopic surgery for PAIS due to os trigonum in high-level athletes.
Methods
The authors retrospectively analyzed high-level athletes (Tegner activity score ≧ 7) who underwent hindfoot endoscopic surgery for PAIS due to os trigonum between March 2018 and May 2023. The minimum follow-up period of the patients was one year. In assessing the surgical results, the visual analogue scale (VAS), the Japanese Society for Surgery of the Foot Ankle-Hindfoot (JSSF) scale, the time to return to the original sport and complications were reviewed. The VAS and the JSSF scale were recorded at the pre-operation and final follow-up. Additionally, to investigate the effect of os trigonum’s size on the surgical results, the patients were divided into 2 groups: the maximum diameter of os trigonum < 10 mm as the group S and the maximum diameter of os trigonum ≧ 10 mm as the group L. Thereafter, the surgical results were statistically compared between the 2 groups.
Results
A total of 16 patients (11 male, 5 female, mean age 30.3±14.0 years, mean Tegner activity score 8.1±1.5) were included in this study. All the athletes could return to the original sport without complications. The mean VAS significantly improved from 63.8 mm at the pre-operation to 11.3 mm at the final follow-up (p < 0.001). The mean JSSF scale significantly increased from 67.6 points at the pre-operation to 91.9 points at the final follow-up (p < 0.001). The mean time to the original sport was 13.8 weeks. Additionally, 8 patients were assigned to the group S, while 8 patients were assigned to the group L. In comparing of the surgical results between the 2 groups, there were no significant differences in the mean VAS and JSSF scale (p > 0.05), while the mean time to return to the original sport was 11.8 weeks in the group S, 15.5 weeks in the group L with significant difference (p < 0.001).
Conclusion
Our findings suggest that hindfoot endoscopic surgery present an effective and safe treatment for PAIS due to os trigonum in high-level athletes. Additionally, larger os trigonum would delay return to the original sport in athletes.