Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Hongxin ^1,2 , ZHAI Longdi ¹ , PAN Zhaoxun ¹ , YU Hongchang ¹ , ZHU Jinhang ¹ ,  TANG Kanglai ²

1. Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China;
2. Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China;

Corresponding author：

TANG Kanglai, Email: tangkanglai@hotmail.com

Keywords：

Ankle impingement syndrome; anterior malleolus; posterior malleolus; approach; arthroscopy

DOI：

10.7507/1002-1892.201904129

Video：

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Objective To investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome.Methods Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups (P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement.Results Median operation time of group A was 50.5 minutes ［95%CI (49.3, 54.6)］, which was significantly shorter than that of group B ［88.5 minutes, 95%CI (76.5, 92.8)］ (Z=−4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups (t=−0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ²=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). The median subjective satisfaction score of group A was 2.0 ［95%(1.4, 1.7)］, which was better than that of group B ［2.0, 95%(1.6, 2.2)］ (Z=−2.480, P=0.013).Conclusion Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang’s approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

Citation： ZHANG Hongxin, ZHAI Longdi, PAN Zhaoxun, YU Hongchang, ZHU Jinhang, TANG Kanglai. Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1340-1344. doi: 10.7507/1002-1892.201904129 Copy

1.	Cosma DI, Vasilescu DE, Corbu A, et al. Combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player-A case report and review of the literature. Clin J Sport Med, 2018.
2.	Ross KA, Murawski CD, Smyth NA, et al. Current concepts review: Arthroscopic treatment of anterior ankle impingement. Foot Ankle Surg, 2017, 23(1): 1-8.
3.	Chen L, Wang X, Huang J, et al. Outcome comparison between functional ankle instability cases with and without anterior ankle impingement: A retrospective cohort study. J Foot Ankle Surg, 2019, 58(1): 52-56.
4.	Yang Q, Zhou Y, Xu Y. Arthroscopic debridement of anterior ankle impingement in patients with chronic lateral ankle instability. BMC Musculoskelet Disord, 2018, 19(1): 239.
5.	Özer M, Yildirim A. Evaluation of the prevalence of Os trigonum and talus osteochondral lesions in ankle magnetic resonance imaging of patients With ankle impingement syndrome. J Foot Ankle Surg, 2019, 58(2): 273-277.
6.	Kudaş S, Dönmez G, Işik Ç, et al. Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes. Acta Orthop Traumatol Turc, 2016, 50(6): 649-654.
7.	Miyamoto W, Takao M, Matsushita T. Hindfoot endoscopy for posterior ankle impingement syndrome and flexor hallucis longus tendon disorders. Foot Ankle Clin, 2015, 20(1): 139-147.
8.	Vilá J, Vega J, Mellado M, et al. Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique. Foot Ankle Surg, 2014, 20(3): 174-179.
9.	Smyth NA, Murawski CD, Levine DS, et al. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. Am J Sports Med, 2013, 41(8): 1869-1876.
10.	Wang X, Zhao Z, Liu X, et al. Combined posterior and anterior ankle arthroscopy for posterior and anterior ankle impingement syndrome in a switching position. Foot Ankle Int, 2014, 35(8): 829-833.
11.	Umans HR, Cerezal L. Anterior ankle impingement syndromes. Semin Musculoskelet Radiol, 2008, 12(2): 146-153.
12.	Niek van Dijk C. Anterior and posterior ankle impingement. Foot Ankle Clin, 2006, 11(3): 663-683.
13.	Yilmaz C, Eskandari MM. Arthroscopic excision of the talar Stieda's process. Arthroscopy, 2006, 22(2): 225.e1-225.e3.
14.	Kreuz PC, Steinwachs M, Erggelet C, et al. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med, 2006, 34(1): 55-63.
15.	Golanò P, Mariani PP, Rodriguez-Niedenfuhr M, et al. Arthroscopic anatomy of the posterior ankle ligaments. Arthroscopy, 2002, 18(4): 353-358.
16.	van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy, 2000, 16(8): 871-876.
17.	韩冠生, 徐斌, 耿春晖, 等. 关节镜下治疗踝关节撞击征的疗效观察. 中国修复重建外科杂志, 2014, 28(6): 673-676.
18.	魏民, 刘洋, 魏钰. 关节镜治疗距下关节创伤性关节炎的临床疗效观察. 中国修复重建外科杂志, 2017, 31(2): 150-154.
19.	Song B, Li C, Chen Z, et al. Combined anterior and dual posterolateral approaches for ankle arthroscopy for posterior and anterior ankle impingement syndrome. Foot Ankle Int, 2016, 37(6): 605-610.
20.	宋斌, 李卫平, 陈仲, 等. 踝关节镜下前方联合跗骨窦入路及后外侧入路治疗踝关节前后联合撞击综合征. 中华创伤杂志, 2015, 31(12): 1085-1088.
21.	Kim HK, Jeon JY, Dong Q, et al. 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, 2013, 52(6): 704-709.
22.	Kim HN, Kim GL, Park JY, et al. Fixation of a posteromedial osteochondral lesion of the talus using a three-portal posterior arthroscopic technique. J Foot Ankle Surg, 2013, 52(3): 402-405.
23.	Lui TH. Arthroscopic treatment of posterior ankle impingement in the supine position using coaxial posterior portals. Foot Ankle Int, 2014, 35(8): 834-837.

1. Cosma DI, Vasilescu DE, Corbu A, et al. Combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player-A case report and review of the literature. Clin J Sport Med, 2018.
2. Ross KA, Murawski CD, Smyth NA, et al. Current concepts review: Arthroscopic treatment of anterior ankle impingement. Foot Ankle Surg, 2017, 23(1): 1-8.
3. Chen L, Wang X, Huang J, et al. Outcome comparison between functional ankle instability cases with and without anterior ankle impingement: A retrospective cohort study. J Foot Ankle Surg, 2019, 58(1): 52-56.
4. Yang Q, Zhou Y, Xu Y. Arthroscopic debridement of anterior ankle impingement in patients with chronic lateral ankle instability. BMC Musculoskelet Disord, 2018, 19(1): 239.
5. Özer M, Yildirim A. Evaluation of the prevalence of Os trigonum and talus osteochondral lesions in ankle magnetic resonance imaging of patients With ankle impingement syndrome. J Foot Ankle Surg, 2019, 58(2): 273-277.
6. Kudaş S, Dönmez G, Işik Ç, et al. Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes. Acta Orthop Traumatol Turc, 2016, 50(6): 649-654.
7. Miyamoto W, Takao M, Matsushita T. Hindfoot endoscopy for posterior ankle impingement syndrome and flexor hallucis longus tendon disorders. Foot Ankle Clin, 2015, 20(1): 139-147.
8. Vilá J, Vega J, Mellado M, et al. Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique. Foot Ankle Surg, 2014, 20(3): 174-179.
9. Smyth NA, Murawski CD, Levine DS, et al. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. Am J Sports Med, 2013, 41(8): 1869-1876.
10. Wang X, Zhao Z, Liu X, et al. Combined posterior and anterior ankle arthroscopy for posterior and anterior ankle impingement syndrome in a switching position. Foot Ankle Int, 2014, 35(8): 829-833.
11. Umans HR, Cerezal L. Anterior ankle impingement syndromes. Semin Musculoskelet Radiol, 2008, 12(2): 146-153.
12. Niek van Dijk C. Anterior and posterior ankle impingement. Foot Ankle Clin, 2006, 11(3): 663-683.
13. Yilmaz C, Eskandari MM. Arthroscopic excision of the talar Stieda's process. Arthroscopy, 2006, 22(2): 225.e1-225.e3.
14. Kreuz PC, Steinwachs M, Erggelet C, et al. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med, 2006, 34(1): 55-63.
15. Golanò P, Mariani PP, Rodriguez-Niedenfuhr M, et al. Arthroscopic anatomy of the posterior ankle ligaments. Arthroscopy, 2002, 18(4): 353-358.
16. van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy, 2000, 16(8): 871-876.
17. 韩冠生, 徐斌, 耿春晖, 等. 关节镜下治疗踝关节撞击征的疗效观察. 中国修复重建外科杂志, 2014, 28(6): 673-676.
18. 魏民, 刘洋, 魏钰. 关节镜治疗距下关节创伤性关节炎的临床疗效观察. 中国修复重建外科杂志, 2017, 31(2): 150-154.
19. Song B, Li C, Chen Z, et al. Combined anterior and dual posterolateral approaches for ankle arthroscopy for posterior and anterior ankle impingement syndrome. Foot Ankle Int, 2016, 37(6): 605-610.
20. 宋斌, 李卫平, 陈仲, 等. 踝关节镜下前方联合跗骨窦入路及后外侧入路治疗踝关节前后联合撞击综合征. 中华创伤杂志, 2015, 31(12): 1085-1088.
21. Kim HK, Jeon JY, Dong Q, et al. 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, 2013, 52(6): 704-709.
22. Kim HN, Kim GL, Park JY, et al. Fixation of a posteromedial osteochondral lesion of the talus using a three-portal posterior arthroscopic technique. J Foot Ankle Surg, 2013, 52(3): 402-405.
23. Lui TH. Arthroscopic treatment of posterior ankle impingement in the supine position using coaxial posterior portals. Foot Ankle Int, 2014, 35(8): 834-837.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome

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