Posterior ankle impingement syndrome: A systematic four-stage approach

Abstract

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.

Hindfoot endoscopic release of the posterior ankle capsuloligamentous structures improves ankle dorsiflexion range, function and pain in patients with painful limitation of ankle dorsiflexion

“…Hindfoot endoscopy is an effective treatment option for posterior bony or soft-tissue impingement. It enables access to posterior ankle cartilage defects and has also been shown to have a quicker recovery than open procedures 4 7 14–16. The authors therefore advocate arthroscopic release in favour of an open release and suggest that anterior ankle arthroscopy is performed at the same time as hindfoot endoscopic release in these patients because after the posterior release is performed and ankle dorsiflexion is restored, anterior soft tissue and bone may impinge as a result.…”

Arthroscopic Surgery in Children and Adolescent – A Domain to Be Developed

“…Posterior ankle impingement syndrome is a recently entity approached with arthroscopic tools [7]. The condition is generated by the mechanical conflict in the rear ankle.…”

“…Despite the small space to work and the neighbourhood of the posterior tibial bundle the technique is reliable giving good access and even better visualisation than open technique. Yasui [7] described a four staged systematic arthroscopic approach to the posterior ankle. After a systematic inspection of the ankle the fragment is removed with a burr.…”

Posterior ankle impingement–an underdiagnosed cause of ankle pain in pediatric patients

“…The pain is aggravated by the aforementioned activities and is typically relieved by rest. The ankle pain is described as consistent, sharp, dull and deep; it is usually difficult for patients to indicate the exact location of the pain in the hindfoot[10,11]. On examination there is posterior joint line tenderness, and more specifically it is typically between the Achilles and peroneal tendons[2,4], which is important to help differentiate it from other causes of posterior foot and ankle pain such as Sever’s apophysitis and ankle sprain.…”