Impingement Syndrome Research Articles

Arthroscopic Patella Realignment for Children And Adolescents: A Single Incision Technique

Management of patellofemoral conditions in children and adolescents can be extremely challenging. Apart from the patellofemoral instability patients, there are several other disorders that can cause significant morbidity, patellofemoral maltracking, patellar tilt, and Hoffa's fat pad impingement syndrome are common problems that may not respond to nonoperative management. Understanding the exact pathology and apply the appropriate management is critical for successful outcome. Identification of novel surgical interventions that can provide symptom relief in a safe manner is important. This technical note describes a surgical technique for patella realignment in young patients that combines safety, simplicity, and reproducibility.

Predicting Outcomes in Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) continues to rise in incidence, and thus there is an increased focus on factors that predict patient outcomes. The factors that impact the outcomes of arthroscopic FAIS treatment are complex. The purpose of this review is to outline the current literature concerning predictors of patient outcomes for arthroscopic treatment of FAIS. Multiple studies have shown that various patient demographics, joint parameters, and surgical techniques are all correlated with postoperative outcomes after arthroscopic FAIS surgery, as measured by both validated patient-reported outcome (PRO) scores and rates of revision surgery including hip arthroplasty. To accurately predict patient outcomes for arthroscopic FAIS surgery, consideration should be directed toward preoperative patient-specific factors and intraoperative technical factors. The future of accurately selecting patient predictors for outcomes will only improve with increased data, improved techniques, and technological advancement.

Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up

To compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years. A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve. Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P= .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P= .999), orconversion to THA (age ≥40: 13.2%, age <40: 3.8%, P= .161) were identified. On Kaplan-Meier analysis, no significant difference (P=.321) was demonstrated in overall gross survivorship between cohorts. Patients with age≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts. Level III, retrospective comparative prognostic trial.

Increased Duration and Intensity of Physical Activity Are Associated With Increased Pain in Individuals With Femoroacetabular Impingement Syndrome: An Ecological Momentary Assessment Study

ObjectiveTo investigate the relation between accelerometer-measured physical activity and real-time pain in individuals with femoroacetabular impingement syndrome (FAIS). We tested the hypothesis that increased duration of high intensity activity would contribute to momentary increases in pain. DesignObservational study. SettingParticipants’ natural, day-to-day environment. ParticipantsPopulation-based sample of 33 individuals with unilateral FAIS. Important eligibility criteria included no concomitant hip disorders or previous hip surgery. Key sociodemographic features include that all participants were required to have a smartphone. InterventionsNot applicable. Main Outcome MeasuresDuration and intensity of physical activity as measured by a waist-worn accelerometer, and instantaneous pain reported in real-time smartphone-based ecological momentary assessment surveys. Physical activity variables included each person's average sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) in the 90 minutes proceeding all pain surveys as well as fluctuation in sedentary, LPA, and MVPA above or below average prior to each individual survey. ResultsLinear mixed models revealed that the significant predictors of pain included fluctuation in sedentary time (B=-0.031, P<.001), average LPA (B=0.26, P=.035), and the interaction between fluctuation in LPA and fluctuation in MVPA (B=0.001, P<.001). Fluctuation in sedentary time above a person's average was associated with lower pain, while average LPA and fluctuations above average in both LPA and MVPA were associated with higher pain. ConclusionsThese results suggest that individuals with FAIS can engage in health-enhancing MVPA but should focus on avoiding concurrent increase above average in both high intensity and LPA in the same 90-minute period. Future work is warranted testing the efficacy of such an approach on pain. Additionally, given that high levels of LPA may arise from a host of socioeconomic factors, additional research is needed to disentangle the effect of LPA on pain in FAIS.

Genetic Influence on Osteoarthritis Versus Other Rheumatic Diseases.

We aimed to compare the genetic contribution to osteoarthritis (OA) versus other rheumatic/musculoskeletal diseases (RMDs) in the same population and to explore the role for any shared genetics between OA and other RMDs. In 59,970 Swedish twins aged 35 years or older, we estimated the heritability (the variance explained by genetic factors) of OA in peripheral joints, back and neck pain, shoulder pain (adhesive capsulitis, impingement syndrome, etc), rheumatoid arthritis, spondyloarthritis (SpA) and psoriatic arthritis, myalgia, and osteoporosis diagnosed in specialist and inpatient care. We also studied how much covariance between OA and each of the RMDs could be explained by genetics by studying phenotypic correlations in bivariate classical twin models. Any-site OA and hip OA (50% and 64%) were among the most heritable RMDs (as compared with 23% for fibromyalgia [lowest] and 63% for SpA [highest]). The highest phenotypic correlations were between OA (any joint site) and shoulder pain in the same individual (r=0.33, 95% confidence interval 0.31-0.35), of which 70% (95% confidence interval 52-88) could be explained by shared genetics. The phenotypic correlation between OA and back/neck pain was r=0.25, with 25% to 75% explained by genetics. Phenotypic correlations between OA and each of the other RMDs were lower (r ~ 0.1 to r ~ 0.2), with inconclusive sources of variation. OA has relatively large heritability as compared with other RMDs. The coexistence of OA and shoulder pain, as well as back pain, was common and could often be explained by genetic factors. Findings imply similar etiologies of OA and several pain conditions.

Біль і можливості фізіотерапії при імпінджмент-синдромі в плечовому суглобі

Introduction: Shoulder problems are the second most common disease of the musculoskeletal system.&#x0D; Background: The most common cause of these problems is impingement syndrome. The aim of our work was to point out the possibilities of conservative treatment for impingement syndrome. In this work, we tried to draw attention to the deterioration in the quality of life caused by shoulder problems and we wanted to improve the range of motion in the shoulder to flexion, abduction, and reduce pain due to the chosen physiotherapy procedures. Our work has a theoretical part, in which we approach the impingement syndrome, its examination and treatment.&#x0D; Material and methods: In the practical part, we used a clinical study with a questionnaire method to achieve the goal of our work. Th e group consisted of 20 patients with impingement syndrome, in whom we used manual therapy, kinesiotherapy, electrotherapy, and Kinesio taping. Using a questionnaire, we were able to assess how much impingement affects the quality of life.&#x0D; Results: Due to the methods we chose, we managed to improve the range of motion of the arm, where the average value at the initial measurement was 119.25° to flexion and 113° to abduction. In the output measurement, the average value up to flexion was 163.25° and up to abduction 165.75°.&#x0D; Conclusion: We also reduced the overall pain, which averaged 6.90 at baseline and 2.90 at the end. Based on our results we recommend a combination of methods to be used in impingement

Ischiofemoral Impingement Syndrome Masked by Proximal Hamstring Tendinopathy as a Cause of Gluteal Pain in a Marathon Runner.

Ischiofemoral Impingement Syndrome Masked by Proximal Hamstring Tendinopathy as a Cause of Gluteal Pain in a Marathon Runner.

Self-Reported Level of Sports Compared With Objective Data in Athletes With Femoroacetabular Impingement Syndrome

Background: Femoroacetabular impingement syndrome (FAIS) is common among ice hockey and soccer players. To evaluate the prevalence of return to sports after hip arthroscopy or level of sports before surgery, self-reported questionnaires such as the Hip Sports Activity Scale (HSAS) are frequently used. There is a risk of self-reporting bias when using these tools. Purpose: To evaluate how self-reported levels of sports using HSAS correspond to objective data. Study Design: Cohort study, Level of evidence: 3. Method: Ice hockey and soccer players undergoing hip arthroscopy for FAIS between 2011 and 2019 and included in the local hip arthroscopy registry in Gothenburg, Sweden, aged ≥18 years at the time of surgery, with a self-reported HSAS level of 7 or 8 before onset of symptoms, were included. Objective data on level of sports were collected through sports-specific sources (https://football.instatscout.com, https://hockey.instatscout.com, https://www.eliteprospects.com, and Swedish Football Association). Objective data were collected for the corresponding season when the athletes reported their symptom onset. Agreement between subjective and objective data was described using descriptive statistics, and comparison between subgroups was made. Results: A total of 483 athletes met the inclusion criteria: 80 ice hockey and 403 soccer players. The majority were men (90%). The mean age was 26.5 years (SD, 8.3 years). When comparing HSAS level with objective data, 112 athletes (23%) had a correct self-reported HSAS level. Of 251 athletes with a self-reported HSAS level of 8, 76 (30%) had a matching objective HSAS level, and 36 of 232 (16%) athletes with a self-reported HSAS level of 7 had a matching objective HSAS level. Of the erroneous subjective ratings, 98% were higher than the objective data. Athletes reporting a correct HSAS level were younger (24.6 vs 26.4 years; P = .04) and had a shorter symptom duration (18 vs 24 months; P < .001). Ice hockey players scored themselves correctly more often than soccer players (P < .001). Conclusion: Only 23% of athletes undergoing hip arthroscopy for FAIS self-reported an HSAS level before onset of symptoms that was accurate according to the objectively recorded data. The majority self-reported an HSAS level above their correct level of sports. Ice hockey players, younger age, and shorter symptom duration were associated with correct self-assessment.

Successful therapy of complex regional pain syndrome after hip arthroscopy for femoroacetabular impingement syndrome: a case report

BackgroundComplex regional pain syndrome is a neuropathic pain disorder associated with ongoing pain that persists beyond the usual expected tissue healing time and that is disproportionate to the degree of tissue injury present. Complex regional pain syndrome after hip arthroscopy has not been reported before. Hip arthroscopy is a fast-growing domain that could lead to an increasing number of complex regional pain syndrome cases, probably owing to the high traction forces that are necessary.Case presentationWe report the case of a 30-year-old German female semiprofessional tennis player who presented with complex regional pain syndrome type I in the lower leg 3 weeks after hip arthroscopy for femoroacetabular impingement syndrome with suture anchor labral repair and femoroplasty. After 2 months of immediate multimodal conservative therapy including administration of gabapentin, prompt full weight-bearing, and intensified physiotherapy, complete recovery was achieved.ConclusionComplex regional pain syndrome does occur after elective hip arthroscopy. Disproportionate postoperative pain or other symptoms raising suspicion of complex regional pain syndrome should be promptly evaluated and treated through a multimodal approach. Postless hip arthroscopy may be advantageous.

Challenges and opportunities in testing sensorimotor processing with tendon vibration and transcranial magnetic stimulation in subacromial impingement syndrome: A case series.

Non-invasive neurostimulation like muscle tendon vibration (VIB) and transcranial magnetic stimulation (TMS) can provide valuable insights on mechanisms underlying sensorimotor dysfunctions. However, their feasibility in the context of painful musculoskeletal disorders like shoulder impingement syndrome (SIS) remain uncertain. The present work used a case series design including 15 participants with SIS, as well as a secondary group-based analysis comparing participants with SIS to 15 healthy counterparts. Proprioceptive processing was tested by VIB-induced kinesthetic illusions of shoulder abduction, and TMS tested corticospinal excitability of the upper trapezius. Detailed individual data were collected, including any technical challenges and feasibility issues encountered. VIB was in general well-tolerated and elicited a perceptible kinesthetic illusion in 13 participants with SIS and 14 controls. TMS presented with several challenges related to discomfort, fear-related behaviors, technical problems and high motor thresholds, especially in participants with SIS. It was only possible to collect all TMS measures in 5 participants with SIS (for both the painful and non/less-painful sides), in 7 controls on their dominant side and 10 controls on the non-dominant side. The only significant group-based analysis was a lower illusion speed/amplitude on the painful versus non-painful side in persons with SIS (p = 0.035). Our study provides preliminary data on challenges encountered with TMS and VIB of trunk/proximal muscle in persons with SIS and healthy counterparts. It might help future studies to better address those challenges beforehand and improve the overall feasibility and impact of neurostimulation tools in musculoskeletal disorders.

Effect of Core Stability Exercises on Shoulder Pain, Muscle Strength, and Range of Motion in Female Swimmers With Shoulder Impingement Syndrome

Background and Aims Previous studies have shown that core stability exercises reduce the applied force on the upper limbs in swimmers. However, the effect of these exercises on the range of motion (ROM), muscle strength, and pain in the shoulder of swimmers is unclear. Therefore, this study aims to investigate the effect of a core stability exercise program on shoulder pain, muscle strength, and ROM in female swimmers with shoulder impingement syndrome (SIS). Methods The study population consists of all female swimmers with SIS in Tabriz, Iran. Twenty eligible swimmers were selected and randomly divided into two exercise (n=10) and control (n=10) groups. The shoulder pain, ROM, and muscle strength were measured by the shoulder pain and disability index, a goniometer, and the bench press (One repetition maximum), respectively. The exercise group participated in a specific core stability exercise program. The data were analyzed in SPSS software, version 24 using repeated measures analysis of variance, independent t-test, and paired t-test for within-group and between-group comparisons. The significance level was set a t 0.05. Results After exercise, the amount of shoulder pain in the experimental group was significantly reduced compared to the control group (P=0.0001). It also had a significant effect on the ROM of the shoulder in this group. In addition, there was a significant difference in shoulder muscle strength in the experimental group before and after exercise (P=0.0001), but this difference was not significant in the control group (P=0.138). Moreover, there was a significant interaction effect of time and group in the shoulder girdle muscle strength (P=0.001). Conclusion The core stability exercises can reduce shoulder pain and improve shoulder ROM and muscle strength in female swimmers with SIS. Performing core stability exercises is recommended to reduce pain and improve shoulder girdle function in these swimmers.

Результаты лечения хронической боли в области плечевого пояса с применением препаратов на основе полинуклеотидов и коллагена

Aim: to evaluate the efficacy and safety of intra- and peri-articular administration of injectable gel implant containing polynucleotides and collagen implants in patients with adhesive capsulitis / impingement syndrome / cervical spondylosis (uncovertebral arthrosis, spondylosis) with clinical reflex and reflex compression signs and orthopedic conditions. Patients and Methods: this prospective multicenter longitudinal 6-month study included 100 men and women (mean age 45 years). The patients were divided into 4 groups (25 patients in each group) based on the diagnosis. Treatment strategy (intra- and peri-articular administration of injectable gel implant containing polynucleotides and collagen implants) was determined by diagnosis and joint inflammation. Before and after treatment, the functional state of the shoulder and pain severity were assessed using questionnaires and laboratory and instrumental tests. Efficacy was assessed by pain relief, improvement in the functional activity of the shoulder joint, and changes in the range of movements in the shoulder joint and cervical spine. Treatment safety was assessed by the adverse effects. Results: after treatment, most patients reported an increase in the range of movements in the cervical spine and shoulder joint, a decrease in pain severity in the cervical spine and shoulder joint, and improvement in the functionality of the shoulder joint. After treatment, a decrease in the CRP levels and ESR was observed. No severe adverse effects were detected. Conclusion: intra- and peri-articular administration of gel implant containing poly-nucleotides and collagen implants for upper shoulder girdle disorders is effective and safe. KEYWORDS: upper shoulder girdle, cervical spine, shoulder joint, chronic pain, polynucleotides, collagen, collagen implant, intraarticular injection, periarticular injection. FOR CITATION: Shcherbakov G.I., Kovtun S.N., Potkina T.N. Outcomes of treatment for chronic shoulder pain using drugs containing polynucleotides and collagen. Russian Medical Inquiry. 2024;8(2):102–109 (in Russ.). DOI: 10.32364/2587-6821-2024-8-2-8.

Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: An Updated Review.

Treatment strategies for femoroacetabular impingement (FAI) syndrome have evolved in tandem with increased comprehension of FAI's impact on hip joint health. Early intervention, including arthroscopic surgery, has gained popularity due to its potential to delay the progression of osteoarthritis. Arthroscopic surgery has demonstrated significant efficacy in treating FAI syndrome, with robust evidence from randomized controlled trials and systematic reviews supporting its use. Despite arthroscopic surgery's success, complications and reoperations are not uncommon. The incidence ranges from 1% to 31% and 4% to 13%, respectively. Adjunctive biologic treatments, such as bone marrow aspirate concentrates and platelet-rich plasma, have shown promise in chondral lesion management. However, robust evidence supporting their routine use in FAI syndrome is currently lacking. Among conservative treatment methods, intra-articular injections offer diagnostic and therapeutic benefits for FAI patients. While they may provide pain relief and aid in prognosis, their long-term efficacy remains a subject of debate. Comparative studies between conservative and arthroscopic treatments highlight the importance of personalized approaches in managing FAI syndrome. In conclusion, recent advancements in FAI syndrome management have illuminated various treatment modalities. Arthroscopic surgery stands as a pivotal intervention, offering substantial benefits in pain relief, function, and quality of life. However, careful patient selection and postoperative monitoring are crucial for optimizing outcomes. Adjunctive biologics and intra-articular injections show promise but require further investigation. Tailoring treatment to individual patient characteristics remains paramount in optimizing FAI syndrome management.

Ultrasound therapy for pain reduction in musculoskeletal disorders: a systematic review and meta-analysis.

Ultrasound therapy is a non-invasive technique used to address a variety of health issues. This systematic review and meta-analysis aim to assess the effectiveness of ultrasound therapy in alleviating pain associated with musculoskeletal diseases. This study was conducted following PRISMA guidelines, with relevant articles identified through comprehensive searches in electronic databases. We conducted searches across multiple databases, including Scopus, PubMed, MEDLINE, ProQuest, Science Direct, CINAHL, AIM, and ELDIS. Two independent reviewers screened the titles and abstracts of the retrieved articles. We included randomized controlled trials (RCTs) and observational cohort studies published between 2010 and 2023 that evaluated ultrasound therapy for knee and shoulder skeletal disorders. The selected data were analyzed qualitatively and synthesized, with the risk of bias assessed using the RoB2 tool. Initially, 117 articles were reviewed using the search strategy, and 10 trials that met the inclusion criteria were identified. In seven of these studies, the primary musculoskeletal disorder was osteoarthritis, while three studies focused on shoulder pain and impingement. Most studies indicated that ultrasound therapy significantly reduced pain. The meta-analysis showed that ultrasound therapy was significantly more effective than other interventions for knee disorders (I 2 = 51%, Z = 2.65, p = 0.008). However, for shoulder disorders, both ultrasound and other intervention methods were found to be ineffective (I 2 = 93%, Z = 0.73, p = 0.46). The current evidence supports the effectiveness of ultrasound therapy in reducing pain and aiding rehabilitation for knee conditions. However, there are mixed results regarding its efficacy for shoulder conditions, highlighting the need for further research in this area.

A randomized control trial: Role of k-cat technique with a specific exercise program in treating painful arc syndrome

A randomized control trial: Role of k-cat technique with a specific exercise program in treating painful arc syndrome

Clinical tests for subacromial impingement syndrome

Clinical tests for subacromial impingement syndrome

Association between Shoulder Dysfunction and Concomitant Neck Disability in Patients with Shoulder Disorders.

This study aimed to investigate the impact of shoulder dysfunction on concomitant neck disability in patients with shoulder disorders. The participants were patients with subacromial impingement syndrome (SIS) and frozen shoulder (FS). Twenty patients with SIS and 21 with FS without cervical radiculopathy were enrolled. The participants were assessed for the 4-week prevalence of neck pain, Neck Disability Index (NDI), shoulder strength and range of motion, a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (quick-DASH), and the Pain Catastrophizing Scale (PCS). The 4-week prevalence of neck pain was 12 out of 20 (60%) in patients with SIS and 13 out of 21 (62%) in patients with FS. The median NDIs were 13 and 12 for SIS and FS, respectively, with no statistically significant difference. About 41% (17/41) of the participants displayed an NDI greater than the cutoff value for disability in daily living. Although shoulder abduction strength correlated with the NDI in patients with SIS, the PCS score correlated with the NDI in patients with FS. Concomitant neck disability is a critical concern for patients with shoulder disorders. The clinical factors related to concomitant neck disability differ between SIS and FS, with specific interventions recommended for each condition.

Comparison of the Effectiveness of the Ultrasound- Guided Subacromial, Acromioclavicular with Subacromial Injection and Suprascapular Nerve Block in Patients with Shoulder Subacromial Impingement Syndrome: A Randomized Controlled, Single Blind, Clinical T

Comparison of the Effectiveness of the Ultrasound- Guided Subacromial, Acromioclavicular with Subacromial Injection and Suprascapular Nerve Block in Patients with Shoulder Subacromial Impingement Syndrome: A Randomized Controlled, Single Blind, Clinical T

A Comparison of 2 Exercise Protocols in Athletes With Primary Subacromial Impingement Syndrome: A Randomized Clinical Trial.

To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. A randomized and controlled clinical study. Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3days a week for 6weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.

Posterior Ankle Impingement: It's Not Only About the Os Trigonum.

Os trigonum and Stieda process are common etiologies for posterior ankle impingement syndrome (PAIS), and diagnosis is typically made by radiographs, computed tomographic, or magnetic resonance imaging. However, these static tests may not detect associated soft tissue and bony pathologies. Posterior ankle and hindfoot arthroscopy (PAHA) is dynamic, providing at least ×8 magnification with full anatomical visualization. The primary aim of this study was to report the prevalence of associated conditions seen with trigonal impingement treated with PAHA. In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions. A total of 111 ankles were studied-74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015). Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS. Level III, retrospective comparative study.