Clinical Outcomes of Posterior Hindfoot Endoscopic Surgery using 1.9-mm Diameter Needle Arthroscopy for Posterior Ankle Impingement in Athletes

Abstract

Category: Arthroscopy; Ankle; Hindfoot; Sports Introduction/Purpose: Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS). However, wound-healing problems following hindfoot endoscopy have been still reported. Recently, a novel 1.9- mm diameter needle-arthroscopic system has been introduced. Its small features can help reduce the risk of wound complications and can have the potential to make it earlier to return to play sports due to its minimally invasiveness. To our knowledge, no studies have been reported regarding PAIS treatment using a 1.9-mm diameter needle-arthroscopy. The purpose of this study was to report the clinical outcomes including return to sports following hindfoot endoscopic surgery using 1.9-mm diameter needle- arthroscopy for PAIS. Methods: Six patients who engaged in athletic activity (mean age 21.7 [range 16-34] years) and were treated by a hindfoot endoscopic surgery using a 1.9-mm diameter arthroscopic system (NanoScopeTM, Arthrex) for PAIS were included. In all patients, os trigonum was resected and flexor hallucis longus (FHL) tenosynovitis was debrided. American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score was evaluated and Visual analog scale (VAS) at 1 day and 2 weeks after surgery were recorded. Time to return to sports activity at preinjury level was also evaluated. Engaged sports included soccer (3 patients), ballet (2 patients), and lacrosse (1 patient). Results: The mean AOFAS score improved significantly from 77.7 to 100 after surgery (p<0.001). Mean VAS score at 1 day and 2 weeks were 1.5 (range 0-3) and 0.3 (range 0-1). respectively. All patients were able to return to full sports activities and the mean time to return to sports activities at preinjury level was 4.8 weeks (range 3-7 weeks). No complications were reported. Conclusion: Posterior hindfoot endoscopy using a 1.9-mm diameter needle-arthroscopy provided excellent clinical outcomes in the treatment of PAIS with relatively earlier return to play sports compared to conventional arthroscopy surgery, although this is not a comparative study. Minimum invasiveness with less postoperative pain using needle-arthroscopy may contribute to its early recovery. Further studies are required to support our results.