2015 ISAKOS Biennial Congress ePoster #136

Results of Impingement Syndrome in 91 Ankles

Kazuya Sugimoto, MD, PhD, Prof., Nara-Shi JAPAN
Shinji Isomoto, MD, PhD, Nara-Shi, Nara JAPAN
Norihiro Samoto, MD, Nara JAPAN
Yuhsuke Nakamoto, MD, Nara-Shi JAPAN
Azusa Yoneda, MD, Nara, Nara JAPAN

Nara Prefectural General Medical Center, Nara, JAPAN

FDA Status Not Applicable

Summary: From Dec. 2008 to Jun. 2013, we experienced 91 ankles of 84 patients with an anterior or/and posterior impingement syndrome. There were 48 anterior and 45 posterior ankle impingements. The results of endoscopic treatment for the ankle impingement syndrome were excellent.

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Abstract:

From December 2008 to June 2013, we experienced 91 ankles of 84 patients with an anterior or/and posterior impingement syndrome. There were 48 anterior and 45 posterior ankle impingements.

(Anterior ankle impingement syndrome: AAIS)
AAIS included impingement lesions in anterior part of the ankle, medial and lateral gutter. There were 32 male and 14 female patients with a mean age of 26 years old ranging from 14 to 69. Thirteen-nine patients were athletes and 18 of them were soccer or rugby football players. Twenty-four ankles showed classical impingement exostosis, 13 detached osteophyte, 6 soft-tissue impingement and 5 fixed osteochondroma. Detached osteophyte is a small fragment and typically located center of the anterior distal tibial end. The soft-tissue impingements are Bassett ligament in 3 ankles, scar formation of the anterior talofibular ligament in 2, and synovial scar in 1.

All the ankle but one is treated surgically using arthroscopy. Repair of the anterior talofibular ligament was performed in 10 patients. Preoperative JOSSM score improved from 82.4 to 96.7 points in mean. Thirteen-seven of 39 athletes returned to their original performance level.

(Posterior ankle impingement syndrome: PIAS)
There were 16 male and 24 female patients with a mean age of 20 years old ranging from 14 to 42. Fifteen patients were ballet dancers and 23 were athletes. Preoperative radiographs showed an Os trigonum in 34 ankles and a large posterior talar process in 11. All of the patients were treated by endoscopic technique using two posterior portals with patients in a prone position under general anesthesia. The operation was consisted of resection of Os trigonum or posterior talar process, resection of distal part of the inter malleolar ligament and release of the flexor hallucis longus tendon. The patients were allowed to walk with full weight bearing on the next day of the operation.

All except one patient with a stress fracture of the contralateral talus returned to their original sports activity 4 weeks after the op. in mean. Thirty-four (89.7%) patients complained of no symptoms one year after the operation. There were 4 patients complained of mild symptoms during dance or sports activity.
The average operation time in the initial 5 patients were 93.8 minutes (66-122) in male and 82.4 (62-105) in female patients and those of the latest 5 patients were 86 (60-118) and 54.4. (52-57).

Discussion

Seventy % of the patients were male in AAIS, and 60% were female in PAIS. Because of variety in lesions, operation time in AAIS is different in each case. While, in PAIS, good learning curve of the operation time was observed in female patients. Endoscopic resection of posterior talar process depends of bone mineral density. The operation requires long time in male patients with hard bones even after experience of more than 30 cases.

Conclusion

The outcome of arthroscopic or endoscopic treatment for the ankle impingement syndrome is excellent and the technique enabled athletes to resume their sports rapidly with few complications.