Anterior Ankle Impingement Syndrome Research Articles

Validation of anterior ankle soft tissue dynamics and shear modulus for anterior ankle impingement syndrome after ankle fracture surgery

Anterior ankle impingement syndrome (AAIS) has been reported to account for a high percentage of complications following ankle fracture surgery. The soft tissue etiology of AAIS is thought to be thickening and inflammation of the anterior ankle soft tissues intervening anteriorly at the tibiotalar joint, causing pain and functional limitation during dorsiflexion. However, the effects of anterior ankle soft tissue dynamics and stiffness on AAIS have yet to be clarified. This study aimed to determine the relationship between AAIS and the anterior ankle soft tissue thickness change ratio and shear modulus using ultrasonography (US). The participants were 20 patients with ankle joint fractures (AO classification A, B) who had undergone open reduction and internal fixation and 20 healthy adults. The evaluation periods were 3 months and 6 months postoperatively. US was used to delineate the tibialis anterior tendon, extensor hallucis longus tendon, and the extensor digitorum longus tendon over the talus and tibia on a long-axis image. Anterior ankle soft tissue thickness was measured as the shortest distance from the most convex part of the talus to the tendon directly above it. The Anterior ankle soft tissue thickness change ratio was determined by dividing the value at 0° dorsiflexion by the value at 10° plantarflexion. The same images as for the anterior soft tissue thickness measurement were drawn for the shear modulus measurement, and the average shear modulus (kPa) was calculated using shear-wave elastography. There was no significant difference in the thickness change ratio between the postoperative and healthy groups. Compared with the healthy group, the shear modulus was significantly higher at 3 and 6 months in the postoperative group (p < 0.01). The shear elastic modulus at 6-month postoperative group was significantly lower than at 3-month postoperative group (p < 0.01). Anterior ankle joint soft tissue stiffness may increase after surgery for an ankle fracture.

The Aggressive Open Anterior Ankle Cheilectomy as Joint Salvage for Anterior Ankle Impingement Syndrome and Arthritis.

Anterior ankle impingement syndrome can frequently present in athletes and post-traumatic patients who have osteophytes contributing to limited dorsiflexion and pain. Surgical treatment options include arthroscopy, open arthrotomy, arthrodesis, and total implant arthroplasty. For many, joint-sparing arthroscopy or arthrotomy yield satisfactory results if significant debridement is performed. If debridement is not aggressive, patients may not obtain the desired improvement. In cases where a larger amount of bone must be removed, or the patient does not have an anatomic appearing talar neck due to osteophytic changes, we have found that an open approach is necessary to achieve good results. To the best of our knowledge, no such technique has been previously published detailing a standard approach to open ankle arthrotomy. Our technique is coined the "Aggressive Open Anterior Ankle Cheilectomy" and involves a systematic 3-step approach. First, the tibial osteophytes are resected with an osteotome; second, the ankle gutters are addressed, and all hypertrophic bones removed; and third, an anatomic talar neck is fashioned. We herein describe our surgical technique and case examples.Level of Evidence: 5.

Relationship between the morphology of osteophytes and cartilage lesions in anterior ankle impingement in athletes: a cross-sectional study

BackgroundThe present study aimed to describe the frequency and severity of tram-track lesions in anterior ankle impingement in athletes and to evaluate the association between osteophyte morphology and severity of tram-track lesions, the distinctive cartilage lesions associated with tibial osteophytes in anterior ankle impingement syndrome.MethodsWe evaluated 34 athletes who underwent arthroscopic osteophyte resection for anterior ankle impingement between January 2017 and March 2021.ResultsWe found tram-track lesions in 26 athletes (76.5%). Arthroscopic findings revealed the distribution of the International Cartilage Repair Society grades of tram-track lesions (grade 0, eight; grade 1, seven; grade 2, ten; grade 3, nine; grade 4, zero). These findings indicate that athletes with anterior ankle impingement syndrome may have more severe cartilage lesions than non-athletes. There was a positive correlation between the International Cartilage Repair Society grade and osteophyte size (r = 0.393, p = 0.021). We divided athletes into two groups according to the presence or absence of osteophyte protrusion into the joint space. Osteophyte protrusion was present in 14 athletes (41.2%). All athletes in the protrusion-type group had tram-track lesions; seven (50%) had International Cartilage Repair Society grade 3. The protrusion-type group’s International Cartilage Repair Society grade was significantly higher than that of the non-protrusion-type group (p = 0.008). The osteophyte sizes in the two groups were not significantly different (p = 0.341).ConclusionsBased on these findings, osteophyte protrusion should be assessed when an indication of arthroscopic treatment for anterior ankle impingement syndrome is considered, particularly in athletes.

Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report

BackgroundCombined anterior and posterior ankle impingement has seldom been reported. Cedell fracture, fracture of posteromedial tubercle of talus, is an uncommon and easily missed injury which may elicit posteromedial ankle impingement. The injury mechanisms and management strategies of these two lesions have been reported individually. But the concurrent lesion of both of them has not been reported.Case presentationWe reported a 58-year-old female with combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in whom open osteophytes debridement, fracture internal fixation and posterior talotibial ligament reconstruction were performed. The AOFAS hindfoot score was 90 at 1 year follow-up. To our knowledge, this was the first reported case with anterior, posterior and posteromedial impingement which was treated operatively with an excellent short-term outcome.ConclusionsTo fully recognize this occult lesion and avoid missing is imperative for reducing the morbidities. We suggest CT and MRI as excellent imaging modalities that can help the timely diagnosis and appropriate treatment for this combined impingement with circumferential lesions.

Arthroscopic Treatment of Anterior Ankle Impingement

Background and objectives:Anterior ankle impingement (as a common cause of anterior ankle pain) is becoming re- cently a common diagnosis in peoples who do excessive dorsiflexion of ankle joint in their daily activities. Arthroscopic debridement is nowadays a gold standard procedure for anterior ankle impingement treatment in both osseous and soft tissue type impingements. The objectives of this study are to provide a comprehensive overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement. Methods:We per- formed a prospective study on 20 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination, the patients complained from either soft tissue or bony impingement. All patients were treated by arthroscopic debridement or burring. Clinical outcome was evaluated according to American orthopedic foot and ankle society score questionnaires, visual analogue scale, and ankle dorsiflexion range achieved. Results: The mean age of the patients was 37.4 year, mean AOFAS ankle hind-foot scale improved from 52.65 preoperatively to 86.95 postoperatively (statistically significant). The mean pain visual analogue scale decreased from 7.9 to 3.1. The mean dorsiflexion angle increased from 7 degrees to 14.5 degrees. Conclusion: Arthroscopic debridement and excision of impinging soft tissues and burring of impinging bones is the treatment of choice for patients with anterior ankle impingement syndrome of both osseous and soft tissue nature after failure of conservative measures to relieve the symptoms and improve the range of motion.

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

To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. 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. 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 (χ 2=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). 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.

Evaluation of the Prevalence of Os Trigonum and Talus Osteochondral Lesions in Ankle Magnetic Resonance Imaging of Patients With Ankle Impingement Syndrome

The prevalence of os trigonum and osteochondral lesions of talus (OCLT) have been presented in different prevalences among different groups in the literature for the patients with ankle impingement syndrome. Our main objective in the study was to determine the possible relationship between the impingement syndrome and the prevalence of os trigonum and OCLT in specific groups. The presence of anterior ankle impingement syndrome (AAIS), posterior ankle impingement syndrome (PAIS), os trigonum, OCLT, and the location of OCLT were evaluated in a blinded manner on magnetic resonance imaging from patients clinically considered to be diagnosed with ankle impingement syndrome from January 2014 to July 2017. The patients were separated into specific groups according to the confirmation of their clinical diagnosis of ankle impingement syndrome on magnetic resonance imaging . A total of 333 patients were included. The prevalence of os trigonum was found to be 1.3% in patients with PAIS(-) AAIS(+), 7.7% in patients with PAIS(-) AAIS(-), 63.3% in patients with PAIS(+) AAIS(-), and 81.1% in patients with PAIS(+) AAIS(+) (p < .001). The prevalence of OCLT was found to be 41.3% in patients with PAIS(-) AAIS(+), 23.1% in patients with PAIS(-) AAIS(-), 18.3% in patients with PAIS(+) AAIS(-), and 27% in patients with PAIS(+) AAIS(+) (p= .005). Our study showed that, for patients with isolated PAIS and AAIS combined with PAIS, the prevalence of os trigonum was 63.3% and 81.1%, respectively, which is more common than previously reported. For patients with isolated AAIS and PAIS, the prevalence of OCLT was 41.3% and 18.3%, respectively. Of the OCLTs combined with ankle impingement syndromes, 87.1% were medially located.

The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus.

The anterior tibiofibular ligament (ATiFL) and its distal fascicle have been the subject of numerous studies, mainly due to the involvement of this ligament in anterolateral soft-tissue impingement of the ankle. There is currently no firm evidence related to the incidence of the distal fascicle or the frequency with which it is in contact with the talus, or whether this is a constant anatomic finding. In addition, the terminology used to refer to this structure is not accurate and varies widely in previous studies. The purpose of this study was to perform an anatomic study on a large number of specimens to clarify the anatomy of the anterior tibiofibular ligament, and specifically its distal fascicle, and its possible role in anterior ankle impingement syndrome. During a 7-year period (2010-2016), cadaveric ankle specimens dissected at our Anatomy Department were included in this study, accounting for a total of 154 ankles. The incidence of the distal fascicle and its contact with the talus were documented. One hundred and seventeen ankles were included [78 men, 39 women, with a median age of 79.3years (range 51-100years)]. The ATiFL was found to have a distal fascicle in 100% of ankles, contacting the anterolateral part of the talus in all cases. The contact was increased in plantarflexion and reduced in dorsiflexion and finally disappeared completely in maximum dorsiflexion. The ATiFL has a constant distal fascicle that is in contact with the talus in the neutral position and in plantar flexion. Contact disappears in maximum dorsiflexion.

Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome

Category: Arthroscopy Introduction/Purpose: We introduce a novel method of combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches in the arthroscopic treatment of posterior and anterior ankle impingement syndrome and compare the postoperative outcomes with conventional anteromedial/anterolateral and posteromedial/posterolateral Methods: From January 2015 to January 2017, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. The patients were divided into the conventional group (n = 13) and the modified group (n = 15) according to the surgical approaches used in the operation. Preoperative and postoperative American Orthopaedic Foot &amp; Ankle Society (AOFAS) score, visual analog scale (VAS) score, range of ankle motion, and operation time were recorded. The average follow-up was 16 months (range 6-24 months). Results: Posterior and anterior ankle impingement syndrome was confirmed arthroscopically in all patients. After the operation, the range of ankle motion in all patients was restored. There was no significant difference in postoperative AOFAS score, VAS score, dorsiflexion, and plantarflexion between the conventional group and the modified group. Moreover, the operation time was significantly reduced in the modified group compared with the conventional group. There was no recurrence of osteophyte and no complications such as infection, neurovascular injury, or delayed healing of surgical incision in the modified group. Conclusion: Dual posterolateral approaches combined with standard anteromedial and anterolateral approaches was a novel method for arthroscopic treatment of posterior and anterior ankle impingement syndrome. It proved to be safe and effective, and significantly reduced the operation time. Reposition, repeated prep and drape, and limb distraction were avoided.

Deep Vein Thrombosis in Combined Ankle Arthroscopy for the Anterior and Posterior Ankle Impingement Syndrome

Introduction: The ankle arthroscopy complication rates from 7.6% to 13.6% and deep vein thrombosis (DVT) is considered as a serious complication. The risk of DVT for patients with isolated foot and ankle conditions, even with plaster cast immobilization, and the possible benefits of mechanical and chemical prophylaxis are poorly studied. Nevertheless, some studies mentioned the risk factors such as injury severity, immobilization, obesity, nonweight-bearing, hindfoot surgery, and tourniquet time. Case Presentation: A 27-year-old male patient, smoker, and casual athlete with complaint of left recurrent painful ankle presented an anterior ankle impingement type B and a posterior impingement syndrome. In the immediate postoperative period, the patient developed a DVT as a complication of a combined ankle arthroscopy (anterior and posterior). Conclusions: It seems that the use of prolonged tourniquet in addition to repositioning the patient may increase the risk of complications such as VTE (venous thromboembolism) and the combination was not included in any published protocol. The current study recommended the use of the Calder antithrombotic recommendations associated with the Caprini risk assessment model in order to cover a greater at-risk population.

Simultaneous ankle arthroscopy and hindfoot endoscopy for combined anterior and posterior ankle impingement syndrome in professional athletes

Simultaneous ankle arthroscopy and hindfoot endoscopy for combined anterior and posterior ankle impingement syndrome in professional athletes

Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome.

We introduce a novel method of combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches in the arthroscopic treatment of posterior and anterior ankle impingement syndrome and compare the postoperative outcomes with conventional anteromedial/anterolateral and posteromedial/posterolateral approaches. From January 2013 to January 2015, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. The patients were divided into the conventional group (n = 13) and the modified group (n = 15) according to the surgical approaches used in the operation. Preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) score, range of ankle motion, and operation time were recorded. The average follow-up was 16 months (range 6-24 months). Posterior and anterior ankle impingement syndrome was confirmed arthroscopically in all patients. After the operation, the range of ankle motion in all patients was restored. There was no significant difference in postoperative AOFAS score, VAS score, dorsiflexion, and plantarflexion between the conventional group and the modified group. Moreover, the operation time was significantly reduced in the modified group compared with the conventional group. There was no recurrence of osteophyte and no complications such as infection, neurovascular injury, or delayed healing of surgical incision in the modified group. Dual posterolateral approaches combined with standard anteromedial and anterolateral approaches was a novel method for arthroscopic treatment of posterior and anterior ankle impingement syndrome. It proved to be safe and effective, and significantly reduced the operation time. Reposition, repeated prep and drape, and limb distraction were avoided. Level IV, retrospective case series.

Current concepts review: Arthroscopic treatment of anterior ankle impingement.

Anterior ankle impingement is a common cause of chronic ankle pain, particularly in athletic populations. Morris and McMurray provided the earliest descriptions of anterior impingement, coining the condition as "athlete's ankle" or "footballer's ankle". The pathology has since been a topic of considerable investigation and has been re-termed "anterior ankle impingement syndrome". Treatment with open surgery has provided good results historically, but at the price of significant complications. Advancements in ankle arthroscopy have decreased the risk of complication drastically and evidence in the literature indicates that anterior arthroscopy is an effective approach to treating osseous and soft tissue impingement. Effective clinical diagnosis and diagnostic imaging are critical for pre-surgical planning. Preoperative detection of anterior osteophytes has been correlated with outcomes. Factors such as joint space narrowing and large osteophytes may also influence outcomes. Therefore, a comprehensive understanding of diagnosis and surgical technique can influence patient outcomes, and patient expectations can be managed around prognostic indicators such as the presence of osteoarthritis. The purpose of this review is to discuss the etiology, clinical presentation, diagnosis, surgical technique, and postoperative rehabilitation of anteromedial and anterolateral anterior ankle impingement syndrome and to evaluate the evidence-based outcomes of arthroscopic management.

Treatment of posterior and anterior ankle impingement syndrome with combined anterior, tarsal sinus and posterolateral approaches under arthroscopy

Objective To discuss the methods and effects of arthroscopic treatment of posterior and anterior ankle impingement syndrome through anterior approach, tarsal sinus approach plus posterolateral approach. Methods The study enrolled 12 patients with posterior and anterior ankle impingement syndrome treated from January 2012 to March 2014. There were 8 males and 4 females, aged17-65 years (mean, 45 years). Left ankle injury was noted in 9 patients and right ankle injury in 3 patients. Eight patients had a history of obvious ankle injury (5 acute and 3 chronic sprains). Arthroscopic surgery was performed to manage the posterior and anterior ankle impingement syndrome through the combined anterior, tarsal sinus and posterolateral approaches, and prone position and posteromedial incision were not used during operation. Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score. Results Operation time was 45-80 min (mean, 62 min). Arthroscopy confirmed anterior bone impingement in all patients. Three patients suffered from posterior bony impingement of the talus, while nine patients os trigonum injury. Duration of follow-up was 10-18 months (mean, 14 months). AOFAS score was (91.4±6.5)points after operation, significantly higher (34.4±12.6)points before operation (t=14.607, P<0.01). All patients had normal ankle range of motion after operation. There were no complications such as neurovascular injury. All the surgical incisions achieved primary healing. Conclusion The procedure avoids body position shift and posteromedial incision during operation, and attains a good vision to the anterior and posterior portions and satisfactory short-term outcome. Key words: Ankle injuries; Arthroscopy; Impingement

Poster 338 Dynamic Point-of-Care Ultrasonography in the Diagnosis and Management of Anterior Ankle Impingement Syndrome: A Case Report

Poster 338 Dynamic Point-of-Care Ultrasonography in the Diagnosis and Management of Anterior Ankle Impingement Syndrome: A Case Report

Simultaneous ankle arthroscopy and hindfoot endoscopy for combined anterior and posterior ankle impingement syndrome in professional athletes

IntroductionThis study aimed to evaluate the clinical outcome of simultaneous less-invasive ankle arthroscopy and hindfoot endoscopy for combined anterior ankle impingement syndrome (AAIS) and posterior ankle impingement syndrome (PAIS) in professional athletes. Materials and methodsBetween October 2009 and October 2011, 12 feet of 9 professional athletes (8 men, 1 woman; mean age 25 years; range 19–34 years) with combined AAIS and PAIS underwent simultaneous ankle arthroscopy and hindfoot endoscopy. Radiography, computed tomography, and magnetic resonance imaging were performed in all patients. Ultrasound-guided anesthetic injection was administered for the diagnosis of PAIS. Active plantar and dorsal flexion angles of the ankle before and after surgery, occurrence of complications, and time to return to competitive sports were evaluated. ResultsAll feet had osteophytes in the anterior ankle joint. Ostrigonum and a large posterior talar process were found in 8 and 4 feet, respectively. Combined disorders that were noted were lateral ankle instability in 6 feet and an osteochondral lesion of the talus in 4 feet. Median JSSF and VAS scores improved significantly from 63 (range 55–69) points preoperatively to 82 (range 77–100) points postoperatively (p<0.01), and from 85 (range 70–95) points preoperatively to 8 (range 3–15) points postoperatively (p<0.01), respectively. Median active plantar and dorsal flexion angles improved significantly from 40° (range, 30°–50°) and 10° (range 5°–20°) preoperatively to 50° (range 40°–55°) and 15° (range 10°–20°) postoperatively, respectively (p<0.01 and p<0.05, respectively). One patient complained of numbness in the vicinity of the sural nerve, which resolved spontaneously by the 4th week after surgery. Median time to return to competitive sports was 12 (range 12–15) weeks. ConclusionSimultaneous ankle arthroscopy and hindfoot endoscopy for combined AAIS and PAIS enables professional athletes to return to athletic activity.

Combined Posterior and Anterior Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome in a Switching Position.

Combined Posterior and Anterior Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome in a Switching Position.

Arthroscopic treatment of traumatic anterior bony ankle impingement

Background Ankle impingement is a common orthopedic problem in sports athletes. It usually results from repetitive ankle sprains, which may lead to long-lasting pain, compromising the athlete’s performance. Impingement syndromes of the ankle involve either osseous or soft-tissue impingement and can be anterior, anterolateral, or posterior. Pain is typically provoked by dorsiflexion of the ankle and palpation of the tibiotalar anterior joint space. Objective The objective of the study was to evaluate the outcome of arthroscopic treatment of the anterior bony ankle impingement syndrome. Patients and methods Fifteen patients (12 men and three women), with a mean age of 37.7 years (27–52 years), who complained of chronic ankle pain and were diagnosed as having bony anterior impingement of the ankle, grades I–III lesions, due to a trauma, without therapeutic response to conservative therapy over 3 months, were treated by arthroscopic excision of the bony spur and debridement of the impingement tissues. The results were evaluated with the American Orthopedics Foot and Ankle Society hindfoot score. The study was designed as a retrospective case series. Results At the end of follow-up, seven patients had excellent scores and were very satisfied with the results and six patients had good scores and were satisfied with the results; hence, about 86.7% had excellent or good results. Two patients had fair results, accounting for 13.3% of all patients; there were no poor results. Conclusion Arthroscopic resection of bony spurs, either tibial or talar, or both, after repeated ankle sprains was proven to be a reliable therapeutic approach for post-traumatic impingement syndrome of the ankle that does not respond to conservative treatment.

Anterior Ankle Impingement and Talar Bony Outgrowths: Osteophyte or Enthesophyte? Paleopathologic and Cadaveric Study With Imaging Correlation

Bony "spurs" are a major component of anterior ankle impingement syndrome. The two major accepted hypotheses on the origin of these bony spurs are osteophyte formation due to repetitive microtrauma and enthesophyte development because of recurrent capsular or ligamentous traction. The purpose of this study was to provide a detailed evaluation of the bony outgrowths that arise on the anterior aspect of the talus and correlate them with the sites of capsular attachment. Twenty-eight well-preserved talus bones from the San Diego Museum of Man were assessed regarding the presence of outgrowths on the anterior aspect of the talus. The distance of the outgrowths from the talar head was measured. The results were correlated with measurements of capsular attachment on the anterior aspect of the talus derived from MR arthrographic images in 13 cadaveric ankles. The average distance of capsular attachment from the talar head in the medial aspect of the bone was 10.63 mm and in the lateral part was 12.04 mm. The mean distance of bony spurs from the talar head in the medial and lateral parts of the talus was 17.2 and 12.5 mm, respectively. Medially, the talar spurs developed more proximally on the neck compared to the capsular attachment (p < 0.01). Laterally, this difference was not significant (p = 0.26). On the medial part of the anterior talus, bone development appears to occur in an intraarticular location (i.e., osteophytes). Laterally, the outgrowths develop extraarticularly and appear to result from capsular and ligamentous traction (i.e., enthesophytes).

Arthroscopic Treatment of Anterior Ankle Impingement Syndrome in Dancers

The purpose of this study was to evaluate the results of arthroscopic treatment of anterior bony and soft-tissue impingement of the ankle in elite dancers. The study is a case series retrospectively reviewed. In the period between 1990 and 1999, 11 elite dancers (12 ankles) had ankle arthroscopy after a diagnosis of anterior ankle impingement that markedly interfered with their dancing. Initial nonoperative treatment failed in all subjects. Previous ankle trauma was noted in all subjects. There were seven women and four men (average age 28 years). Tibiotalar exostoses were radiographically noted in six ankles. Standard anteromedial and anterolateral arthroscopic portals and instrumentation were used for resection of bone spurs and debridement of impinging soft tissues. Patients were nonweightbearing for 5 days after surgery and had postoperative physiotherapy. Nine dancers returned to full dance activity at an average of 7 weeks after surgery. One patient did not return to dance performance because of concurrent unrelated orthopaedic problems, but he resumed work as a dance teacher; he developed a recurrent anterior tibial spur that was successfully resected at a second arthroscopy 9 years later. Another dancer developed postoperative scar-tissue impingement and stiffness; she had a repeat arthroscopy 4 months after the initial procedure and subsequently returned to dance performance. All patients eventually had marked postoperative improvement in pain relief and dance performance. Arthroscopic debridement is an effective method for the treatment of bony and soft-tissue anterior ankle impingement syndrome in dancers and has minimal morbidity.