Arthroscopic Treatment of Anterior Ankle Impingement

Abstract

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed. Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as "poor" (< 60 points) and 8 cases rated as "fair" (60-67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.

Arthroscopic Treatment for Anterior Impingement Exostosis of the Ankle: Application of Three-Dimensional Computed Tomography

“…Branca et al 2 clarified the results of arthroscopic treatment of AIE according to Scranton's classification, and found the best results are obtained in stage I and II. In stage III and IV, where the damage was extensive, there were recurrences of the osteophytes, probably resulting from insufficient removal of the tibial and talar osteophytes and from degeneration.…”

“…In some people they cause anterior ankle pain and limit dorsiflexion of the ankle during activity. The symptoms caused by osteophytes are variously called athlete's ankle, 8 footballer's ankle, 7 anterior ankle impingement, 2,11,12,14,18 anterior tibiotalar spur, 15 anterior ankle osteophytes, 3 or anterior impingement exostosis (AIE). 10,13,16 .…”

Combined Posterior and Anterior Ankle Arthroscopy

“…Even though in the literature, some investigators have reported technical difficulties in addressing posteromedial lesions and in performing posterior ankle synovectomy [6, 7], we have not experienced this problem, using the 2-portal endoscopic hindfoot technique [4, 8]. In most cases chronic anterior ankle pain is caused by an anterior impingement syndrome, tibiotalar anterior osteophytes, intra-articular foreign bodies, local synovitis, or osteochondral defects [9]. These conditions will markedly reduce ankle function especially limiting dorsiflexion due to an anterior impediment and capsular contracture [9].…”

“…In most cases chronic anterior ankle pain is caused by an anterior impingement syndrome, tibiotalar anterior osteophytes, intra-articular foreign bodies, local synovitis, or osteochondral defects [9]. These conditions will markedly reduce ankle function especially limiting dorsiflexion due to an anterior impediment and capsular contracture [9]. Anterior ankle joint pathology can be treated by means of an anterior ankle arthroscopy [10].…”

Arthroskopie des oberen Sprunggelenks zur Therapie des posttraumatischen Impingementsyndroms Grad I-III nach Scranton

“…Die Mehrzahl der Untersucher bestätigt jedoch eine positive Korrelation zwischen Langzeitergebnis und begleitender Knorpelläsion [5,11,22,24].…”