Skip to main content

Arthroscopic treatment combined with the ankle stabilization procedure is effective for sinus tarsi syndrome in patients with chronic ankle instability

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 3135–3139 (2018)Cite this article

Abstract

Purpose

This study aimed to investigate the results of arthroscopic treatment combined with ankle stabilization procedure for sinus tarsi syndrome (STS) in patients with chronic ankle instability (CAI).

Methods

A total of 57 patients (31 males and 26 females, average age 29.9 ± 8.4 years ranging from 15 to 52 years) with STS and CAI who accepted operation from 2013 to 2015 were included in this retrospective study. Surgical procedures included thorough tarsal sinus debridement and repair or reconstruction of lateral ankle ligaments according to the quality of ligaments. American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and Tegner score were evaluated preoperatively and at final follow-up.

Results

All the patients accepted thorough debridement of tarsal sinus. Of these, 53 patients (93.0%) had an arch structure between the posterior subtalar joint and the middle subtalar joint. Further, 54 patients accepted lateral ankle ligament repair, and 3 patients accepted ligament reconstruction. A total of 40 patients were followed up with an average time of 30.7 months. The modified AOFAS score increased from 62.5 (27–90) to 93 (67–100), the Karlsson score increased from 57 (30–82) to 90 (55–100), and the Tegner score increased from 1 (1–3) to 5 (1–8).

Conclusions

Arthroscopic treatment combined with the ankle stabilization procedure could get satisfactory results for STS in patients with CAI. The arch structure composed by medial calcaneal component of the medial root of the inferior extensor retinaculum (MCC) might contribute to the pathological mechanism of STS.

Level of evidence

IV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Ahn JH, Lee SK, Kim KJ, Kim YI, Choy WS (2009) Subtalar arthroscopic procedures for the treatment of subtalar pathologic conditions: 115 consecutive cases. Orthopedics 32:891

    Article  Google Scholar 

  2. Aydıngöz Ü, Melih Topcuoğlu O, Görmez A, Cankurtaran T, Dilara Topcuoğlu E, Bilge Ergen F (2016) Accessory anterolateral talar facet in populations with and without symptoms: prevalence and relevant associated ankle MRI findings. AJR Am J Roentgenol 9:1–6

    Google Scholar 

  3. Barbaix E, Van Roy P, Clarys JP (2000) Variations of anatomical elements contributing to subtalar joint stability: intrinsic risk factors for post-traumatic lateral instability of the ankle? Ergonomics 43:1718–1725

    Article  CAS  Google Scholar 

  4. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley JA, DeFrate LE (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37:2241–2248

    Article  Google Scholar 

  5. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU (2016) Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24:1022–1028

    Article  Google Scholar 

  6. Choisne J, Hoch MC, Alexander I, Ringleb SI (2017) Effect of direct ligament repair and tenodesis reconstruction on simulated subtalar joint instability. Foot Ankle Int 38:324–330

    Article  Google Scholar 

  7. Frey C, Feder KS, DiGiovanni C (1999) Arthroscopic evaluation of the subtalar joint: does sinus tarsi syndrome exist? Foot Ankle Int 20:185–191

    Article  CAS  Google Scholar 

  8. Helgeson K (2009) Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther 4:29–37

    PubMed  PubMed Central  Google Scholar 

  9. Hua YH, Chen SY (2010) Combination of modified Broström procedure with ankle arthroscopy for chronic ankle instability accompanied by intra-articular symptoms. Arthroscopy 26:524–528

    Article  Google Scholar 

  10. Kamiya T, Kura H, Suzuki D, Uchiyama E, Fujimiya M, Yamashita T (2009) Mechanical stability of the subtalar joint after lateral ligament sectioning and ankle brace application: a biomechanical experimental study. Am J Sports Med 37:2451–2458

    Article  Google Scholar 

  11. Keefe DT, Haddad SL (2002) Subtalar instability—etiology, diagnosis, and management. Foot Ankle Clin 7:577–609

    Article  Google Scholar 

  12. Klein MA, Spreitzer AM (1993) MR imaging of the tarsal sinus and canal: normal anatomy, pathologic findings, and features of the sinus tarsi syndrome. Radiology 186:233–240

    Article  CAS  Google Scholar 

  13. Lee KB, Bai LB, Song EK, Jung ST, Kong IK (2008) Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. Arthroscopy 24:1130–1134

    Article  Google Scholar 

  14. Matsui K, Burgesson B, Takao M, Stone J, Guillo S, Glazebrook M (2016) Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:1040–1048

    Article  Google Scholar 

  15. O’Connor D (1958) Sinus tarsi syndrome: a clinical entity. J Bone Joint Surg Am 40:720

    Google Scholar 

  16. Oloff LM, Schulhofer SD, Bocko AP (2001) Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases. J Foot Ankle Surg 40:152–157

    Article  CAS  Google Scholar 

  17. Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA, Easley ME (2016) Systematic quantification of stabilizing effects of subtalar joint soft-tissue constraints in a novel cadaveric model. J Bone Joint Surg Am 98:842–848

    Article  Google Scholar 

  18. Pieters RS, Galvin J (2015) The rare presentation of sinus tarsi syndrome secondary to metastasis in a patient with endometrial carcinoma. Radiol Case Rep 6:414

    Article  Google Scholar 

  19. Ringleb SI, Udupa JK, Siegler S, Imhauser CW, Hirsch BE, Liu J, Odhner D, Okereke E, Roach N (2005) The effect of ankle ligament damage and surgical reconstructions on the mechanics of the ankle and subtalar joints revealed by three-dimensional stress MRI. J Orthop Res 23:743–749

    Article  CAS  Google Scholar 

  20. Weindel S, Schmidt R, Rammelt S, Claes L, Campe A, Rein S (2010) Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130:313–319

    Article  CAS  Google Scholar 

  21. Yamamoto H, Yagishita K, Ogiuchi T, Sakai H, Shinomiya K, Muneta T (1998) Subtalar instability following lateral ligament injuries of the ankle. Injury 29:265–268

    Article  CAS  Google Scholar 

  22. Zwipp H, Bemmerl JG, Holch M et al (1991) Sinus tarsi and canalis tarsi syndromes. A post-traumatic entity. Foot Ankle Surg 2:181–188

    Article  Google Scholar 

Download references

Author information

Author notes

    Affiliations

    1. Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China

      Sheng-Kun Li, Yu-Jie Song, Hong Li, Ying-Hui Hua & Hong-Yun Li

    2. Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

      Baofu Wei

    Authors
    1. Sheng-Kun Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Yu-Jie Song
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Hong Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Baofu Wei
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Ying-Hui Hua
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Hong-Yun Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Ying-Hui Hua or Hong-Yun Li.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no competing interests.

    Funding

    The study was supported by National Natural Science Foundation of China (NSFC81572209).

    Ethical approval

    Ethical approval was obtained from the Institutional Review Board (IRB) from Huashan Hospital, Fudan University: No.KY2016-002 and agreement.

    Additional information

    Sheng-Kun Li and Yu-Jie Song have contributed equally to this work.

    Ying-Hui Hua and Hong-Yun Li have contributed equally to this work.

    Rights and permissions

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Cite this article

    Li, SK., Song, YJ., Li, H. et al. Arthroscopic treatment combined with the ankle stabilization procedure is effective for sinus tarsi syndrome in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 26, 3135–3139 (2018). https://doi.org/10.1007/s00167-017-4813-2

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00167-017-4813-2

    Keywords

    • Ankle stabilization
    • Arthroscopic treatment
    • Chronic ankle instability
    • Sinus tarsi syndrome