Arthroscopic ankle debridement relieves pain, improves function in NFL players

All of the 16 patients studied returned to playing professional football at an average of 67 days.

Issue: December 2009

One of the first studies examining the results of arthroscopic ankle decompression for professional football players with anterior ankle impingement indicates that the procedure is effective for these athletes.

“Arthroscopic debridement is a safe and reliable treatment option for National Football League players and results in significant improvement in pain [relief], outcome scores and dorsiflexion,” Bryson P. Lesniak, MD, said during his presentation at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting.

Anterior ankle impingement

Lesniak and his colleagues retrospectively studied the results of 14 professional football players in the same National Football League franchise who underwent a total of 16 consecutive ankle arthroscopies performed by a single surgeon during a 15-year period. All of the players had preoperative isolated ankle pain with dorsiflexion and decreased range of motion. The investigators excluded paints with ankle instability from the study.

The study group averaged slightly older than 28 years. Six players had previously documented ankle sprains. In addition, one patient had a prior ankle fracture and another had an ankle dislocation.

All of the patients underwent a synovectomy using anterior medial and anterior lateral portals, as well as soft tissue and osseous decompression to restore the normal contours of the tibial component and dorsal aspect of the talus, Lesniak said.

The arthroscopy revealed that approximately half of the players had at least grade II cartilage changes and 25% had minimal cartilage changes. Ten patients had loose bodies removed during the procedure.

Significant improvements

“We had a significant change from preoperative to postoperative range of motion of approximately 10·,” Lesniak said. However, he noted that the patients did not obtain a full range of motion.

The investigators also discovered that the Visual Analog Pain Scale score significantly decreased from 4.7 points preoperatively to 0.5 points postoperatively. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score significantly improved from 66 points to 98 points.

All of the patients returned to play at an average of 67 days. Lesniak noted that this figure could be misleading since most of the surgeries were performed immediately after the playing season. Therefore, patients did not return to full sport until training camp which began approximately 2-months postoperatively.

Two patients also had residual pain at the time they returned to play. One of these patients had a previous dislocation and the other had a previous ankle fracture.

“All patients returned to professional football for at least 1 year,” Lesniak said. “Two patients retired after that subsequent year.”

He cited the short follow-up and retrospective study design as limitations. “In our population, [they] may continue to play through pain, so return to play may not be as cut and dry as we might like for an outcome,” Lesniak said.

For more information:

Bryson P. Lesniak, MD, can be reached at the University of Miami, Leonard M. Miller School of Medicine, Room 303, Rehabilitation Center, P.O.Box 016960 (D-27), Miami, FL 33101; 305-689-5500. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

Lesniak BP, Iso A, Norwig JA, et al. Analysis of arthroscopic ankle decompression in professional football players. Presented at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting. June 9-12, 2009. Keystone, Colo.