Arthroscopic Treatment of Posterior Ankle Impingement Syndrome: Mid-Term Clinical Results and a Learning Curve

Abstract

To report mid-term clinical results of posterior ankle arthroscopy in the treatment of posterior ankle impingement syndrome (PAIS) and to assess the learning curve and its influence on the results. Methods: This was a retrospective evaluation of the clinical outcomes of posterior ankle arthroscopy and its learning curve in a series of patients with PAIS. Demographic and clinical data, surgical time, the American Orthopaedic Foot Ankle Society (AOFAS) ankle/ hindfoot scores, and time to resumption of sports were recorded. Results: Fifty-nine patients with 72 posterior ankle arthroscopies were evaluated at a mean follow-up period of 60 months (24-133 months). Causes of PAIS were an os trigonum (50), a large posterior talar process ( 14), and soft-tissue impingement (8). There were 29 male and 30 female patients. The average age was 21.8 years (12-74 years). The average preoperative AOFAS score improved significantly from 79.6 to 97.6 postoperatively (P < .0001). The average time taken to resume training was 5.3 weeks, and the time to return to a competitive condition was 13.4 weeks. The times to resumption of training were shorter in elite athletes than local competitive athletes. The learning curve of the posterior ankle arthroscopy was detected and determined by a logarithmic trendline and moving averages. An experience of 26 cases was required to be proficient in posterior arthroscopies. The postoperative AOFAS scores were not statistically different between the initial and the latest 10 series each. Conclusions: The mid-term follow-up results of endoscopic treatment for the PAIS were good, with a high success rate in returning to sports activities. Although a learning curve effect was detected in our series of arthroscopic treatment for the PAIS due to os trigonum, a low volume of experience did not affect the results. Level of Evidence: Level IV, therapeutic case series.E lite athletes, such as football players and dancers, are the most common patients to develop posterior ankle impingement syndrome (PAIS). [1][2][3][4] Bony impingement by an os trigonum or by a large posterior talar process is the major cause of the syndrome. [5][6][7][8] In

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement

“…Our study cohort did not consist of elite athletes but the return to sport time was shorter than the participants in the study by Sugimoto et al. 13 This might be potentially attributable to the smaller portal size and less associated soft-tissue trauma from smaller instruments, which may facilitate an earlier return to sport. Miyamoto et al.…”

“…They also found that the time to return to play was shorter in elite athletes compared with local athletes. Our study cohort did not consist of elite athletes but the return to sport time was shorter than the participants in the study by Sugimoto et al 13 This might be potentially attributable to the smaller portal size and less associated softtissue trauma from smaller instruments, which may facilitate an earlier return to sport. Miyamoto et al 14 performed simultaneous anterior ankle arthroscopy and hindfoot endoscopy for 9 athletes with impingement symptoms.…”

“…In our smaller cohort, mean time of return to sports was 4.8 weeks or roughly 34 days. Similarly, Sugimoto et al 13 reported on 59 patients who underwent posterior ankle arthroscopy for the treatment of PAIS with a mean follow-up period of 60 months and found that the average time taken to resume training was 5.3 weeks. They also found that the time to return to play was shorter in elite athletes compared with local athletes.…”

Ankle Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents

“… 22 This may hinder a surgeon’s readiness to adopt this procedure in an academic setting, as resident involvement may slow efficiency. Even at the attending surgeon level, a prolonged learning curve for ankle arthroscopy has been reported 23 and may require advanced training. 24 As such, a lack of highly specialized ankle arthroscopists associated with academic institutions may be contributing to the variability in case exposure that we found.…”

“…Initially used as a diagnostic tool, this procedure is now widely indicated for the management of intra-articular ankle pathology. 31 While ankle arthroscopy is most commonly used to treat soft tissue and bony impingement, 23 , 32 , 33 osteochondral defects, 34 , 35 , 36 and intra-articular loose bodies, 31 many surgeons now advocate for concomitant or staged arthroscopic intervention during the treatment of lateral ankle instability. 14 For example, the combined use of ankle arthroscopy and peroneal tendon retinacular repair has increased by 50% from 2007 to 2011.…”