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Combined arthroscopic management of concurrent posterior and anterior ankle pathologies

Abstract

Purpose

To determine the technical feasibility and preliminary clinical efficacy of performing simultaneous arthroscopic management in cases with combined posterior and anterior ankle pathologies utilizing previously described standard arthroscopic procedures within a single surgical sitting.

Methods

Nineteen consecutive patients with combined anterior and posterior ankle pathologies were included in the current study, after at least 6 months of failed conservative managements. Combined standard posterior and anterior ankle arthroscopy was performed in all patients within the same surgical session; first with the patient in the prone position, then with the patient turned onto the supine position to perform the anterior procedure.

Results

All patients were available for the follow-up; the median follow-up period was 33 months (range 22–61 months). No persistent neurological deficits or infections were recorded. The American Orthopedic Foot and Ankle Society Ankle and Hind foot Scale score significantly improved from 70.2 ± 15.2 points preoperatively to reach 93.0 ± 5.4 points at 1 year post-operatively (p < 0.001). Sixteen patients (84.2 %) returned to their previous activity levels.

Conclusions

Combined arthroscopic management of concurrent posterior and anterior ankle pathologies within the same surgical session is initially clinically encouraging; it allows for an earlier return to activities of daily living without a significantly added morbidity.

Level of evidence

Case series, Level IV.

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References

  1. 1.

    Acevedo JI, Busch MT, Ganey TM, Hutton WC, Ogden JA (2000) Coaxial portals for posterior ankle arthroscopy: an anatomic study, with clinical correlation on 29 patients. Arthroscopy 16(8):836–842

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Allegra F, Maffulli N, Cerza F, Delianni E (2009) Posteromedial approach procedure in the supine position for one-step anterior and posterior ankle arthroscopy. Sports Med Arthrosc 17(3):185–189

    PubMed  Article  Google Scholar 

  3. 3.

    Allegra F, Maffulli N (2010) Double postero-medial portals for posterior ankle arthroscopy in supine position. Clin Orthop Relat Res 468(4):996–1001

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4.

    Bojanic I, Bergovec M, Smoljanovic T (2009) Combined anterior and posterior arthroscopic portals for loose body removal and synovectomy for synovial chondromatosis. Foot Ankle Int 30(11):1120–1123

    PubMed  Article  Google Scholar 

  5. 5.

    Bureau NJ, Cardinal E, Hobden R, Aubin B (2000) Posterior ankle impingement syndrome; MR imaging findings in seven patients. Radiology 215(2):497–503

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Corte-Real NM, Moreira RM, Guerra-Pinto F (2012) Arthroscopic treatment of tenosynovitis of the flexor hallucis longus tendon. Foot Ankle Int 33(12):1108–1112

    PubMed  Google Scholar 

  7. 7.

    Coughlin MJ, Mann RA (1993) Tarsal tunnel syndrome. In: Mann RA, Coughlin MJ (eds) Surgery of the foot and ankle, 6th edn. Mosby, St. Louis, pp 554–558

    Google Scholar 

  8. 8.

    Cutsuries AM, Saltrick KR, Wagner J, Catanzariti AR (1994) Arthroscopic arthroplasty of the ankle joint. Clin Podiatr Med Surg 11(3):449–467

    PubMed  CAS  Google Scholar 

  9. 9.

    de Leeuw PA, Golano P, van Dijk CN (2008) A 3-portal endoscopic groove deepening technique for recurrent peroneal tendon dislocation. Tech Foot Ankle Surg 7(4):250–256

    Article  Google Scholar 

  10. 10.

    Deng DF, Hamilton GA, Lee M, Rush S, Ford LA, Patel S (2012) Complications associated with foot and ankle arthroscopy. J Foot Ankle Surg 51(3):281–284

    PubMed  Article  Google Scholar 

  11. 11.

    Gougoulias NE, Agathangelidis FG, Parsons SW (2007) Arthroscopic ankle arthrodesis. Foot Ankle Int 28(6):695–706

    PubMed  Article  Google Scholar 

  12. 12.

    Guo QW, Hu YL, Jiao C, Ao YF, Tian DX (2010) Open versus endoscopic excision of a symptomatic os trigonum: a comparative study of 41 cases. Arthroscopy 26(3):384–390

    PubMed  Article  Google Scholar 

  13. 13.

    Hamilton WG (1993) Foot and ankle injuries in dancers. In: Mann RA, Coughlin MJ (eds) Surgery of the foot and ankle, 6th edn. Mosby, St. Louis, pp 1241–1276

    Google Scholar 

  14. 14.

    Hampton CB, Shawen SB, Keeling JJ (2010) Positioning technique for combined anterior, lateral, and posterior ankle and hind foot procedures: technical tip. Foot Ankle Int 31(4):348–350

    PubMed  Article  Google Scholar 

  15. 15.

    Henderson I, La Valette D (2004) Ankle impingement: combined anterior and posterior impingement syndrome of the ankle. Foot Ankle Int 25(9):632–638

    PubMed  Google Scholar 

  16. 16.

    Jacobson K, Ng A, Haffner KE (2011) Arthroscopic treatment of anterior ankle impingement. Clin Podiatr Med Surg 28(3):491–510

    PubMed  Article  Google Scholar 

  17. 17.

    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot hallux and lesser toes. Foot Ankle Int 15(7):349–353

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Kim HK, Jeon JY, Dong Q, Kim HN, Park YW (2013) Ankle arthroscopy in a hanging position combined with hindfoot endoscopy for the treatment of concurrent anterior and posterior impingement syndrome of the ankle. J Foot Ankle Surg 52(6):704–709

    PubMed  Article  Google Scholar 

  19. 19.

    Lawson JP (1985) Symptomatic radiographic variants in the extremities. Radiology 157(3):625–631

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Liu SH, Nuccion SL, Finerman G (1997) Diagnosis of anterolateral ankle impingement: comparison between magnetic resonance imaging and clinical examination. Am J Sports Med 25(3):390–394

    Article  Google Scholar 

  21. 21.

    Lombardi CM, Silhanek AD, Connolly FG (1999) Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: operative technique and case study. J Foot Ankle Surg 38(5):347–351

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Lui TH, Chan WK, Chan KB (2006) The arthroscopic management of frozen ankle. Arthroscopy 22(3):283–286

    PubMed  Article  Google Scholar 

  23. 23.

    Lui TH (2008) Ankle arthroscopy with patient in prone position. Arch Orthop Trauma Surg 128(11):1283–1285

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    McGahan PJ, Pinney SJ (2010) Current concept review: osteochondral lesions of the talus. Foot Ankle Int 31(1):90–101

    PubMed  Article  Google Scholar 

  25. 25.

    Mizel MS, Hecht PJ, Marymont JV, Temple HT (2004) Evaluation and treatment of chronic ankle pain. J Bone Joint Surg Am 86:622–632

    Google Scholar 

  26. 26.

    Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, Femino JE, Amendola A (2012) Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am 94(5):439–446

    PubMed  Article  Google Scholar 

  27. 27.

    Ogut T, Ayhan E, Irgit K, Sarikaya AI (2011) Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 19(8):1355–1361

    PubMed  Article  Google Scholar 

  28. 28.

    Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85(7):989–993

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Scholten PE, Seirevelt IN, van Dijk CN (2008) Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am 90(12):2665–2672

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Scholten PE, van Dijk CN (2012) Case report: combined posterior and anterior ankle arthroscopy. Case Rep Orthop 2012:693124. doi:10.1155/2012/693124

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Schweitzer ME, van Leersum M, Ehrlich SS, Wapner K (1994) Fluid in normal and abnormal ankle joints: amount and distribution as seen on MR images. Am J Roentgenol 162(1):111–114

    Article  CAS  Google Scholar 

  32. 32.

    Tol JL, van Dijk CN (2006) Anterior ankle impingement. Foot Ankle Clin 11(2):297–310

    PubMed  Article  Google Scholar 

  33. 33.

    Tol JL, Verheyen CP, van Dijk CN (2001) Arthroscopic treatment of anterior impingement in the ankle. J Bone Joint Surg Br 83(1):9–13

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    van Dijk CN, Scholten PE, Krips R (2000) A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 16(8):871–876

    PubMed  Article  Google Scholar 

  35. 35.

    van Dijk CN, van Bergen CJ (2008) Advancements in ankle arthroscopy. J Am Acad Orthop Surg 16(11):635–646

    PubMed  Google Scholar 

  36. 36.

    van Dijk CN (2006) Anterior and posterior ankle impingement. Foot Ankle Clin 11(3):663–683

    Article  Google Scholar 

  37. 37.

    van Dijk CN (2006) Hindfoot endoscopy. Foot Ankle Clin 11(2):391–414

    PubMed  Article  Google Scholar 

  38. 38.

    Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ (2008) Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy 24(2):196–202

    PubMed  Article  Google Scholar 

  39. 39.

    Zengerink M, van Dijk CN (2012) Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 20(8):1420–1431

    PubMed  Article  PubMed Central  Google Scholar 

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Correspondence to Nasef Mohamed Nasef Abdelatif.

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Abdelatif, N.M.N. Combined arthroscopic management of concurrent posterior and anterior ankle pathologies. Knee Surg Sports Traumatol Arthrosc 22, 2837–2842 (2014). https://doi.org/10.1007/s00167-014-2980-y

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Keywords

  • Ankle arthroscopy
  • Combined anterior and posterior pathology
  • Simultaneous management