Arthroscopic Debridement of Pediatric Accessory Anterolateral Talar Facet Causing Impingement

Abstract

Symptomatic subfibular and/or lateral talocalcaneal impingement in pediatric patients may result from an accessory anterolateral talar facet (AALTF). This impingement may cause pain and disability and may limit athletic performance in high-level athletes. We report the case of a 12-year-old female competitive gymnast who had refractory, lateral-sided right ankle pain for 4 months and underwent right ankle arthroscopic resection of the AALTF causing impingement. Standard medial and anterolateral portals with the addition of an accessory anterolateral-distal portal were used in conjunction with a 30 2.7-mm-diameter arthroscope. The AALTF was resected with a combination of a shaver and a motorized rasp. Intraoperative fluoroscopy was used to verify successful debridement of the bony facet. This case illustrates that arthroscopic debridement is a technique to treat subfibular and/or talocalcaneal impingement associated with an AALTF.

Accessory anterolateral talar facet impingement with tibialis spastic varus foot

“…5 Seven feet underwent AALTF resection. In 2016, Neumann et al 6 reported one foot treated with arthroscopic AALTF resection; however, they did not describe the presence of foot deformity in their case. To our knowledge, there is no report of AALTF impingement with TSVF.…”

“…We searched the PubMed database on 20 April 2017 for all case reports of AALTF impingement and identified four such clinical reports. [3][4][5][6] In 53 previously reported feet, 39 flatfeet were included. In all, 46 of 53 feet were treated surgically.…”

“…MRI demonstrated abutting bone marrow edema between the talus and calcaneus. [3][4][5][6]15 This was localized to AALTF and the adjacent calcaneus anterior to the posterior facet. CT scans and MRI were useful for diagnosis in the current case.…”

“…In 2008, Martus et al first reported an association between rigid flatfoot and AALTF during adolescence. A search of the PubMed database showed that 53 feet with AALTF impingement including 39 flatfeet have been reported; [3][4][5][6] however, there is no report of AALTF impingement with tibialis spastic varus foot (TSVF).…”

Endoscopic Management of Calcaneofibular Impingement and Posterior Ankle Impingement Syndrome Caused by Malunion of Joint Depressed–Type Calcaneal Fracture

“…Ankle arthroscopy portals can be used if the impingement is above the level of the posterior subtalar joint. 9 Lateral subtalar portals are used if the impingement is below the level of the posterior subtalar joint (e.g., after calcaneal malunion). 2 , 3 The calcaneofibular impingement makes the space between the calcaneus and lateral malleolus markedly limited, and the space is always filled up with thick fibrous tissue.…”