True submalleolar accessory ossicles causing impingement of the ankle

Abstract

True ossicle in the distal portion of the malleolus is only sporadically observed, and related disease has been rarely reported. We present two cases of atypical ankle impingement resulting from an ankle sprain. Plain radiographs revealed true submalleolar ossicles. Conservative treatment failed, and arthroscopy was performed. Instability of the ossicle and surrounding fibrotic soft tissue was evident; a gap between the ossicle and the tip of the malleolus seen during plantar flexion of the ankle disappeared in dorsal flexion, resulting in compression of the surrounding soft tissue. Arthroscopic excision of the accessory ossicle relieved the symptoms and enabled both patients to return to full preinjury activities.

The Role of the Accessory Malleolar Ossicles and Malleolar Avulsion Fractures in Lateral Ankle Ligament Reconstruction

“…However, they excluded all patients with ankle instability and those with ankle injuries 6 months prior to treatment. 32 Similar findings were seen in case reports by Vega et al 49…”

“…However, they excluded all patients with ankle instability and those with ankle injuries 6 months prior to treatment. 32 Similar findings were seen in case reports by Vega et al 49 Japanese authors Mitani et al and Noguchi et al recommended initial operative treatment for patients with avulsion fractures or ossicle separation to prevent chronic ankle instability. 50,51 Noguchi et al noted that 31 out of 41 (76%) patients treated operatively for ATFL tear with avulsion fracture showed no residual instability, whereas only 34 out of 56 (52%) patients treated conservatively displayed stable ankle joints at follow-up.…”

Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle

“…Distraction of the ankle was not used for this procedure. The ankle was kept in neutral to dorsiflexion throughout the surgery, which allows good visualization and easy access to the anterior talofibular ligament (ATFL) and surrounding tissues [9].…”

All-inside Arthroscopic Lateral Collateral Ligament Repair for Ankle Instability With a Knotless Suture Anchor Technique

“…17 Dorsiflexion of the ankle without distraction allows good visualisation and easy access to the lateral and medial recesses of the ankle. 41 The all-inside arthroscopic technique for lateral collateral ligament repair requires creation of 3 portals. An accessory anterolateral portal was performed during the procedure.…”