Abstract
PurposeThe etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome.MethodsEighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation.ResultsFrom the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury.ConclusionProfessional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury.Level of evidenceIV.
Highlights
Os trigonum ankle syndrome refers to a posterior ankle impingement pathology, often characterised by posterior ankle pain in plantar flexion
All forty professional athletes that required os trigonum surgery had some involvement of lateral ligament injury to the ankle on magnetic resonance imaging (MRI); 37 players (94.1%) had a chronic lateral ligament injury [Table 1]
Three (5.9%) athletes that underwent os trigonum surgery, had an acute lateral ankle ligament injury on MRI
Summary
Os trigonum ankle syndrome refers to a posterior ankle impingement pathology, often characterised by posterior ankle pain in plantar flexion. It is frequently observed in athletes where the mechanism of injury is either overuse or direct trauma [15, 18, 21]. The clinical prognosis appears to be better in those presenting with overuse injuries rather than trauma [12, 19]. The incidence of os trigonum syndrome in the athletic population is variable, ranging between 1.7 and 50%. Available data suggests that between 33 and 50% of athletes present bilaterally. There does not appear to be an increased prevalence between men and women, nor
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