Hindfoot Endoscopy for Posterior Ankle Impingement: Surgical Technique

• Published in: Journal of bone and joint surgery. American volume 2009-10, Vol.91 (Supplement_2 Suppl 2), p.287-298
• Main Authors: van Dijk, C.N, de Leeuw, P.A.J, Scholten, P.E
• Format: Article
• Language: English
• Subjects: Ambulatory Surgical Procedures - methods; Ankle Injuries - pathology; Ankle Injuries - surgery; Arthroscopes; Arthroscopy - methods; Biological and medical sciences; Decompression, Surgical - methods; Diseases of the osteoarticular system; Follow-Up Studies; Humans; Injury Severity Score; Male; Medical sciences; Minimally Invasive Surgical Procedures - methods; Orthopedic Procedures - methods; Pain Measurement; Prospective Studies; Range of Motion, Articular - physiology; Recovery of Function; Risk Assessment; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.I.00445

BACKGROUNDThe surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less morbidity and facilitates a quick recovery compared with open surgery.METHODSFifty-five consecutive patients with posterior ankle impingement were treated with an endoscopic removal of bone fragments and/or scar tissue. The symptoms were caused by trauma (65%) or overuse (35%). All patients were enrolled in a prospective protocol. At baseline, the age, sex, work and sports activities, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, and preinjury Tegner scores were determined for all patients. At the time of follow-up, AOFAS hindfoot scores and Tegner scores were assessed and the time to return to work and sports activities was determined. Complications were recorded. Patients scored the overall result as poor, fair, good, or excellent by means of a 4-point Likert scale.RESULTSThe median duration of follow-up was thirty-six months, and no patient was lost to follow-up. The median AOFAS hindfoot score increased from 75 points preoperatively to 90 points at the time of final follow-up. The median time to return to work and sports activities was two and eight weeks, respectively. At the time of follow-up, patients in the overuse group were more satisfied than those in the posttraumatic group, and the AOFAS hindfoot scores were higher in patients in the overuse group (median, 100 points) compared with patients in the posttraumatic group (median, 90 points). A complication occurred in one patient who had a temporary loss of sensation of the posteromedial aspect of the heel.CONCLUSIONSThe outcome after endoscopic treatment of posterior ankle impingement compares favorably with the results of open surgery reported in the literature. Hindfoot endoscopy appears to cause less morbidity than open ankle surgery and facilitates a quick recovery. Patients treated for posterior ankle impingement caused by overuse have better results than those treated following trauma.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.ORIGINAL ABSTRACT CITATION“Hindfoot Endoscopy for Posterior Ankle Impingement” (2008;90:2665-72).