Arthroscopic treatment of anterior impingement in the ankle

Abstract

We performed a prospective study to assess the long-term outcome of 57 arthroscopic debridement procedures carried out to treat anterior impingement in the ankle. Using preoperative radiographs, we grouped patients according to the extent of their osteoarthritis (OA). The symptoms of those with grade-0 changes could be attributed to anterior soft-tissue impingement alone. Patients with grade-I disease had both anterior soft-tissue and osteophytic impingement, but no narrowing of the joint space. In those with grade-II OA, narrowing of the joint space was accompanied by osteophytic impingement. Radiographs taken before and after operation and at follow-up were compared to assess the recurrence of osteophytes and the progression of narrowing of the joint space. At a mean follow-up of 6.5 years (5 to 8) all patients without OA had excellent or good results. There were excellent or good results in 77% of patients with grade-I OA, despite partial or complete recurrence of osteophytes in two-thirds. In most patients with grade-II OA, narrowing of the joint space had not progressed at follow-up. There was a notable improvement in pain in these patients, 53% of whom had excellent or good results. Although some osteophytes recurred, at long-term follow-up arthroscopic excision of soft-tissue overgrowths and osteophytes proved to be an effective way of treating anterior impingement of the ankle in patients who had no narrowing of the joint space.

Treatment of osteochondral defects of the talus

“…Both series also reported a high rate of recurrence of osteophytes. 86,394 However, no statistical correlation was seen between recurrence of osteophytes and return of symptoms.…”

“…426 Th is fi nding was later confi rmed in two long-term follow-up studies. 86,394 Because the alternative in these osteoarthritic patients is arthrodesis, a 50% success rate is acceptable. Both series also reported a high rate of recurrence of osteophytes.…”

“…It is known that osteophytes frequently recur, often asymptomatic, after treatment. 394 We had hypothesized that the size of the OCD would be a significant predictor of outcome, as has been reported in some of the previous studies that investigated predictors of outcome of arthroscopic treatment of OCDs (Table 4). 44,76,77,82,128,156,165,190,235,244,334 However, none of the predictive factors investigated in the present study was found to be significantly associated with the clinical or radiographic outcome.…”

“…50,93,279,395 The hypothesis of traction is not plausible because the anterior joint capsule is attached more proximally to the site where the tibial spurs originate. 394,396,426 In trauma secondary to or associated with supination stress, damage to the non-weight-bearing cartilage rim occurs. 422 A repair reaction is initiated, with cartilage proliferation, scar tissue formation, and calcification.…”

Ankle Osteoarthritis

“…The arthroscope can help to remove these loose bodies and bone spurs and smooth the cartilage surfaces of the ankle joint.Arthroscopic debridement for impingement had a 75% success rate at 5 years in the presence of spurs, but only 50% with loss of joint space (21).…”