Management of Posterior Impingement in the Ankle in Athletes and Dancers

Coetzee, J. N.; Seybold, Jeffrey D.; Moser, Brad R.; Stone, Rebecca M.

doi:10.1177/1071100715595504

Cited by 25 publications

(31 citation statements)

References 18 publications

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“…However, if athletic patients want to return to athletic activity promptly, then surgical intervention can be recommended early in the treatment process. Options include open treatment or arthroscopic intervention[ 3 , 22 , 23 ]. The advantages of arthroscopic procedures for PAIS are that they are less invasive, have a lower risk of postoperative complications, and shorter recovery time for returning to full activity.…”

Section: Treatmentmentioning

confidence: 99%

“…The advantages of arthroscopic procedures for PAIS are that they are less invasive, have a lower risk of postoperative complications, and shorter recovery time for returning to full activity. However, the technical difficulty and relatively steep learning curve are disadvantages[ 3 ]. Additionally, it is difficult to perform simultaneous treatments for anterior ankle pathologies using a posterior two-portal approach, while subtalar arthroscopy or conventional ankle arthroscopy with posterolateral (PL) portal are more available[ 24 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Recently, a systematic review by Zwiers et al[ 9 ] highlighted the advantages of the endoscopic approach over the open approach including lower complication rates, shorter recovery time, less blood loss, less postoperative pain, and comparable functional outcomes. However, concerns with the technique remain; including the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Posterior ankle impingement syndrome: A systematic four-stage approach

Yasui¹,

Hannon²,

Hurley³

et al. 2016

WJO

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Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior ankle impingement syndrome: A systematic four-stage approach

Yasui¹,

Hannon²,

Hurley³

et al. 2016

WJO

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“…The traditional open surgical excision of the os trigonum through a posteromedial or posterolateral approach has good results and relatively few complications and provides the advantage of performing FHL tenolysis versus an arthroscopic approach. 7,15 Additionally, a hindfoot endoscopic technique 33 has shown comparable clinical outcomes regarding pain, function, and satisfaction and may shorten the recovery time and result in lower complication rates. 4,12 However, it limits access to concomitant FHL pathology.…”

mentioning

confidence: 99%

“…Postoperatively, dancers typically return to dance within 2-3 months after a rigorous and structured course of physical rehabilitation therapy. 7,15,18,20 Here, we demonstrate a retrospective case series of 44 dancers who were evaluated after undergoing surgical excision of a symptomatic os trigonum that resulted in secondary PAIS.…”

mentioning

confidence: 99%

Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series

Walsh

Durante

Moser

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Management of ankle pain in dancers can be challenging because of the repetitive stress and complex demands placed on this region. Despite the prevalence of ankle injuries in this population, literature on surgical outcomes and return to dance is limited. Purpose: To retrospectively evaluate the efficacy and functional outcomes after surgical excision of a symptomatic os trigonum in dancers. Study Design: Case series; Level of evidence, 4. Methods: Between June 2006 and June 2016, a total of 44 dancers underwent surgical excision of a symptomatic os trigonum at a single institution and by a single surgeon. All patients presented with symptoms of posterior ankle impingement syndrome and subsequently failed nonsurgical treatment. Clinical analysis was conducted using various pre- and postoperative patient-reported outcome questionnaires, including the Veterans RAND 12-Item Health Survey (VR-12), Foot Function Index–Revised (FFI-R), and visual analog scale (VAS) for pain, as well as subjective patient satisfaction. Results: A total of 44 patients (54 ankles; mean age, 18.2 years) were retrospectively evaluated at a mean follow-up of 33.4 months. The VR-12 Physical Health score improved from a mean score of 37.8 ± 11.9 to 51.2 ± 10.5 ( P < .001). The cumulative FFI-R score improved from 46.45 ± 13.8 to 31.2 ± 9.7 ( P = .044), with the subcategory of “activity limitation” representing the highest-scoring FFI-R subcategory at 65.28 ± 13.4 preoperatively and improving to 34.47 ± 12.4 at follow-up ( P < .001). The mean VAS score for subjective pain improved significantly from 5.39 ± 2.84 to 1.73 ± 2.10 ( P < .00044). Conclusion: Overall, the findings of the present study demonstrate that dancers of varying style and level improved significantly according to various clinical measures. Patients included in this study reported that they returned to their previous level of dance upon completion of physical therapy and maintained thriving postoperative careers, which for several meant dancing at the professional level.

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Sprunggelenk und Achillessehne

Reuter

2020

Angewandte Sportphysiotherapie - Untere Extremität

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Management of Posterior Impingement in the Ankle in Athletes and Dancers

Abstract: Level of Evidence: Level V, expert opinion.

Cited by 25 publications

References 18 publications

Posterior ankle impingement syndrome: A systematic four-stage approach

Posterior ankle impingement syndrome: A systematic four-stage approach

Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series

Sprunggelenk und Achillessehne

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