Posterior ankle arthroscopy effective for treating posterior ankle impingement

Complications included temporary numbness and ankle stiffness, but there were no cases of permanent neurovascular injury or wound infection.

Performing posterior ankle arthroscopy with patients placed in the prone position may be a safe and effective surgical option for treating posterior ankle impingement, a retrospective study suggests.

"Functional and clinical evaluations following [posterior ankle arthroscopy] revealed that all patients were very satisfied. They reported good-to-excellent health-related quality-of-life scores, satisfactory functional outcomes and a high rate of return to sporting activities," the authors said in the study. "Most importantly, no significant complications were encountered."

Kevin Willits, MD, FRCSC, and colleagues at the University of Western Ontario and the University of Iowa Hospitals in Iowa City reviewed clinical outcomes for 16 ankles (15 patients) treated with posterior ankle arthroscopy for posterior ankle pain. They published their results in Arthroscopy.

Patients averaged 25 years of age; follow-up averaged 32 months.

All cases had a primary diagnosis of either a posterior ankle or subtalar joint disorder, based on clinical symptoms and radiographic findings, according to the study.

"All 15 patients had tenderness to palpation in the posteromedial aspect of the ankle and had preoperative radiographs, which included standard anteroposterior, lateral and mortise views of the ankle," the authors reported.

"The indication for surgery was persistent posterior ankle pain despite a minimum of 3 months [of a] conservative treatment protocol, which included physiotherapy, orthotics and oral anti-inflammatories, as well as activity modification," they wrote.

The investigators performed all procedures using the surgical technique described by van Dijk, which involves placing the patient in the prone position, using a two-portal endoscopic approach and maintaining tourniquet control of the operative limb, according to the study.

At final follow-up, Health Survey Short Form-12 scores averaged 51.8 points for the mental component and 55.8 points for the physical component. Scores for the American Orthopaedic Foot and Ankle Society ankle and hindfoot scale averaged 91 points, and scores for the Lower Extremity Functional Scale averaged 75 points, according to the study.

Complications included five patients with temporary numbness in the scar region and one patient with temporary ankle stiffness.

"There were no permanent neurovascular injuries and no wound infections or other complications reported," the authors wrote.

"All patients stated that they were either moderately or very satisfied with the result of their surgery, and all but one patient stated that they would definitely have the surgery again if required," they noted.

Patients returned to work after an average of 1 month and returned to sporting activities after an average of 5.8 months. Fourteen patients returned to their preinjury athletic levels, the researchers wrote.

For more information:
Willits K, Sonneveld H, Amendola A, et al. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy. 2008;24:196-202.