Posterior Impingement Syndrome Research Articles

Injury prevention and physiotherapy procedures for ankle injuries in ballet dancers

The aim of this study was to investigate the most frequent, effective and up-to-date injury prevention and physiotherapy procedures used in relation to ballet dancers’ ankle injuries. A literature review with a qualitative analysis was performed using the following databases: PubMed, SAGE, ScienceDirect, PlosOne and Cochrane Library. The inclusion criteria were: both genders, age > 18, journal impact factor > 0, age of study ≤ 10 years and the following search keywords were used: “ankle”, “injury”, “ballet”, “dancers”, “physiotherapy”, “physical therapy” and “prevention”. A total of 520 articles were found, out of which six were determined to be appropriate according to the inclusion and exclusion criteria. They dealt with the prevention/rehabilitation of ankle sprains (N=2), tendinopathy of the Achilles tendon (N=2), tendinitis of the m. hallucis longus (N=4), rupture of the Achilles tendon (N=2), and anterior (N=3) and posterior (N=4) impingement syndrome. It was found that for injury prevention in ballet, strengthening and stretching exercises are the most often used methods, while rest, ice therapy, muscle strengthening exercises, foot braces and dance technique optimisation are the most frequently used methods in injury management. These seem to also be the most up-to-date injury prevention and physiotherapy procedures, while the most effective procedures could not be retrieved due to a lack of relevant studies, which prevented the quantitative comparison of their effectiveness. The published clinical evidence endorses physiotherapy/kinesiotherapy as an effective ankle injury prevention and management modality in ballet dancers, although additional studies with a better quality of methodology are required.

Epidemiological Characteristics of Foot and Ankle Injuries in 2 Professional Ballet Companies: A 3-Season Cohort Study of 588 Medical Attention Injuries and 255 Time-Loss Injuries.

The foot and ankle are often reported as the most common sites of injury in professional ballet dancers; however, epidemiological research focusing on foot and ankle injuries in isolation and investigating specific diagnoses is limited. To investigate the incidence rate, severity, burden, and mechanisms of foot and ankle injuries that (1) required visiting a medical team (medical attention foot and ankle injuries; MA-FAIs) and (2) prevented a dancer from fully participating in all dance-related activities for at least 24 hours after the injury (time-loss foot and ankle injuries; TL-FAIs) in 2 professional ballet companies. Descriptive epidemiological study. Foot and ankle injury data across 3 seasons (2016-2017 to 2018-2019) were extracted from the medical databases of 2 professional ballet companies. Injury-incidence rate (per dancer-season), severity, and burden were calculated and reported with reference to the mechanism of injury. A total of 588 MA-FAIs and 255 TL-FAIs were observed across 455 dancer-seasons. The incidence rates of MA-FAIs and TL-FAIs were significantly higher in women (1.20 MA-FAIs and 0.55 TL-FAIs per dancer-season) than in men (0.83 MA-FAIs and 0.35 TL-FAIs per dancer-season) (MA-FAIs, P = .002; TL-FAIs, P = .008). The highest incidence rates for any specific injury pathology were ankle impingement syndrome and synovitis for MA-FAIs (women 0.27 and men 0.25 MA-FAIs per dancer-season) and ankle sprain for TL-FAIs (women 0.15 and men 0.08 TL-FAIs per dancer-season). Pointe work and jumping actions in women and jumping actions in men were the most common mechanisms of injury. The primary mechanism of injury of ankle sprains was jumping activities, but the primary mechanisms of ankle synovitis and impingement in women were related to dancing en pointe. The results of this study highlight the importance of further investigation of injury prevention strategies targeting pointe work and jumping actions in ballet dancers. Further research for injury prevention and rehabilitation strategies targeting posterior ankle impingement syndromes and ankle sprains are warranted.

Anterior ankle impingment syndrome is less frequent, but associated with a longer absence and higher re-injury rate compared to posterior syndrome: a prospective cohort study of 6754 male professional soccer players

PurposeTo study the epidemiology and return to play characteristics of anterior and posterior ankle impingement syndromes (AAIS and PAIS) over 18 consecutive seasons in male professional soccer players.MethodsBetween the 2001–2002 and 2018–2019 seasons, 120 European soccer teams were followed prospectively for various seasons. Time loss injuries and player exposures were recorded individually in 6754 unique players. Injury incidence and burden were reported as the number of injuries and days absence per 1000 h with 95% confidence intervals (CIs). Injury severity was reported as median absence in days with the interquartile range (IQR).ResultsOut of 25,462 reported injuries, 93 (0.4%) were diagnosed as AAIS (38%) or PAIS (62%) in 77 players. AAIS and PAIS were similar regarding injury characteristics except for a greater proportion of AAIS having a gradual onset (69% vs.47%; P = 0.03) and being re-injuries (31% vs. 9%; P = 0.01). Impingement syndromes resulted in an overall incidence of 0.03 injuries (95% CI 0.02–0.03) per 1000 h and an injury burden of 0.4 absence days per 1000 h. PAIS incidence was significantly higher than that for AAIS [0.02 (95% CI 0.002–0.03) vs. 0.01 (95% CI 0.005–0.01) injuries per 1000 h (RR = 1.7). The absence was significantly longer in AAIS than in PAIS [10 (22) vs. 6 (11) days; P = 0.023]. Impingement syndromes that presented with a gradual onset had longer absences in comparison to impingement with an acute onset [8 (22) vs. 5 (11) days; P = 0.014]. Match play was associated with a higher incidence and greater injury burden than training: 0.08 vs. 0.02 injuries per 1000 h (RR 4.7), respectively, and 0.9 vs. 0.3 days absence per 1000 h (RR 2.5).ConclusionAnkle injuries are frequent in men’s professional soccer and ankle impingement is increasingly recognized as a common source of pain, limited range of motion, and potential time loss. In our study, ankle impingement was the cause of time loss in less than 0.5% of all injuries. PAIS was more frequently reported than AAIS, but AAIS was associated with more absence days and a higher re-injury rate than PAIS. The findings in this study can assist the physician in best practice management on ankle impingment syndromes in professional football.Level of evidenceII.

A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions.

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n=33, 50.8%), and the most common coalition type was non-osseous (n=57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p=0.028, p=0.010, p=0.023, and p=0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25-78.59]; p=0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14-11.78]; p=0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.

Arthroscopic treatment through Tang's approach in the treatment of posterior talus impingement syndrome

Objective: To analyze the efficacy of arthroscopic posterior ankle debridement through Tang's approach for the treatment of impingement of posterior tubercle of the talus. Methods: A retrospective analysis was performed on 64 patients (35 males and 29 females) with posterior tubercle impingement of the talus who underwent surgical treatment from September 2011 to May 2019 in First Affiliated Hospital of Military Medical University of the Army. The disease occurred in left foot in 31 cases and in right foot in 33 cases, with an age ranged from 15 to 65 years ((36±7) years). All patients underwent arthroscopic debridement of the posterior tubercle of the talus through Tang's approach, in which the patients were placed in the lateral decubitus position, and the arthroscopic access was constructed via the lateral malleolus apex approach and the posterolateral Achilles tendon approach. All patients were assessed preoperatively and postoperatively with the American Association of Ankle Surgeries (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) for pain, as well as imaging, and the data were compared before and after the operation. Results: All patients were followed-up effectively for (15.6±4.2) months. The preoperative AOFAS ankle-hind foot function score was (84±11) points, and it was (92±9) points at the last follow-up (P<0.05); the VAS score for preoperative pain was (4.5±3.0) points and it was (1.0±0.3) points at the last follow-up (P<0.05). The distance from the preoperative posterior tubercle of the talus to the perpendicular to the tangent line in the imaging evaluation was (4.0±2.0) mm, the vertical distance between the posterior edge of calcaneal joint surface and tangent line was (-8.4±4.2) mm, and the average vertical distance between posterior tubercle of talus and tangent line was (-7.9±4.6) mm after operation, the exposed distance from the lower joint was (-2.1±3.0) mm after operation. Conclusions: Arthroscopic debridement of the posterior tubercle of talus through Tang's approach can effectively alleviate the symptoms caused by the posterior tubercle of talus. Tang's approach has the advantages of avoiding repeated position change and disinfection, and reducing the possibility of infection.

Morphological features of the deep component of the posterior inferior tibiofibular ligament.

The deep component of the posterior inferior tibiofibular ligament (PITFL) was classified by type in this large-scale cadaveric study to provide basic information that will help elucidate the mechanisms underlying ankle joint posterior impingement syndrome. This investigation examined 100 legs from 49 Japanese cadavers (mean age at death, 79 ± 11years; 58 sides from men, 42 from women). In classification, absence of an independent fiber of the deep component of the PITFL were classified as Type I, an independent fiber of the deep component of the PITFL was classified as Type II-a, an independent fiber of the deep component of the PITFL with bundles of fibers connected to the posterior intermalleolar ligament (PIML) was classified as Type II-b, and an independent fiber of the deep component of PITFL with a band shape connected to the PIML was classified as Type III. A deep component of the PITFL was present in all specimens. An independent fiber of the deep component of the PITFL was present in 37 legs (37%), connecting to the deep component of the PITFL and PIML in 26 (70.3%). Several types of deep component of the PITFL were identified: Type I in 63 legs (63%); Type II-a in 11 (11%); Type IIb in 12 (12%); and Type III in 14 (14%). No significant differences were seen between the right and left legs. Type I male were significantly more than Type I female (p < 0.05). Type III female were significantly more than Type III male (p < 0.05). Strong relationships exist between the PITFL and PIML.

Morphological features of the posterior intermalleolar ligament.

In the present study, the posterior intermalleolar ligament (PIML) was classified by type using large-scale cadavers to provide basic information to help elucidate the mechanism of ankle joint posterior impingement syndrome. This investigation examined 100 legs from 49 Japanese cadavers (mean age at death, 79 ± 11years; 58 sides from men, 42 from women). In the classification method, an absent PIML was classified as Type I, a PIML with one fiber bundle (attachment to one place) was Type II, a PIML with two fiber bundles (attachment to two places) was Type III, and a PIML with three fiber bundles (attachment to three or more places) was Type IV. Furthermore, according to other adhering tissues, they were further subdivided and classified by type. There were various types of PIML: 19 (19%) Type I; 24 (24%) Type II; 23 (23%) Type III; and 34 (34%) Type IV. A PIML was present in 81 legs (81%). There were no significant differences between men and women and between left and right sides. The complex relationships of the PIML with the surrounding ligaments and tissues are considered to be among the factors that make interpretation of imaging findings difficult.

Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement

To investigate the mid-to-long-term efficacy of patients with chronic ankle instability combined with posterior impingement syndrome after 3-9 years of follow-up, and to analyze the influencing factors. From February 2010 to December 2015, 46 patients underwent concurrent lateral ankle ligament repair with posterior ankle arthroscopic surgery at the Institute of Sports Medicine, Peking University Third Hospital. The patient was first placed in a prone position and underwent arthroscopic debridement for the posterior impingement. After finishing the posterior arthroscopy, the surgeon and assistants first translated the patient to the affected side, then turned to the healthy side, and changed the position to the supine position. During the turning over, another assistant held the arthroscope and the instrument to ensure that it was sterile and could be used without replacement. The anterior ankle arthroscopy was operated if necessary and the lateral ankle ligament repair was anatomic repaired with anchors. The 42 patients were followed up, including 26 males and 16 females. The average age was (28.9±10.0) years. The patient's clinical symptoms, joint stability, mobility and motor function were compared by questionnaire and physical examination. The preoperative and postoperative visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores were compared, and the clinical scores and the patient age, gender, height and weight were compared. The correlations between body mass index (BMI), preoperative duration, surgery duration, and cartilage injury were analyzed. The mean follow-up time was (71.8±22.8) months. The postoperative VAS scores (1.0 vs. 5.0, P<0.001), AOFAS scores (92 vs. 80, P<0.001), and Tegner scores (6.5 vs. 2, P<0.001) were significantly superior to the preoperative levels. The excellent and good rate was 97.6%. The postoperative VAS score (t=2.719, P=0.10), AOFAS score (t=-2.853, P=0.10), Tegner score (t=-3.443, P=0.001) and time to return exercise (t=2.814, P=0.008) were negatively correlated with the patient age, and the postoperative VAS score was negatively correlated with cartilage injury (Z=-2.195, P=0.028). The mid-to-long-term clinical outcomes of the chronic ankle ligament instability combined with the posterior impingement were good. The age of the patients was negatively correlated with the clinical outcome. The combined cartilage injury could aggravate the postoperative pain.

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.

Current Concepts in Extra-articular Impingement of the Hip: Clinical Diagnosis, Imaging, and Treatment.

AbstractHip impingement syndromes, particularly femoroacetabular impingement syndrome, have attracted tremendous attention in the past decade. We address some of the less common hip impingement syndromes, mainly the extra-articular hip impingement syndromes. The clinical presentation, imaging, and treatment of anterior, posterior, and lateral hip impingement syndromes are discussed.

Multimodal assessment of sensorimotor shoulder function in patients with untreated anterior shoulder instability and asymptomatic handball players.

Functional evaluation of sensorimotor function of the shoulder joint is important for guidance of sports-specific training, prevention and rehabilitation of shoulder instability. Such assessment should be multimodal and comprise all qualities of sensorimotor shoulder function. This study evaluates feasibility of such multimodal assessment of glenohumeral sensorimotor function in patients with shoulder instability and handball players. Nine patients with untreated anterior instability of their dominant shoulder and 15 asymptomatic recreational handball players performed proprioceptive joint position sense and dynamic stabilization evaluations on an isokinetic device, as well as a functional throwing performance task. Outcome measures were analysed individually and equally weighted in a Shoulder-Specific Sensorimotor Index (S-SMI). Finally, isokinetic strength evaluations were conducted. We observed comparable sensorimotor functions of unstable dominant shoulders compared to healthy, contralateral shoulders (e.g. P=0.59 for S-SMI). Handball players demonstrated superior sensorimotor function of their dominant shoulders exhibiting a significantly higher throwing performance and S-SMI (P<0.001 and P=0.002, respectively), but comparable internal rotator peak torques for both shoulders (P>0.22). The present study proves feasibility of multimodal assessment of shoulder sensorimotor function in overhead athletes and patients with symptomatic anterior shoulder instability. Untreated shoulder instability led to a loss of dominance-related sensorimotor superiority indicating functional internal rotation deficiency. Dominant shoulders of handball players showed a superior overall sensorimotor function but weakness of dominant internal rotation constituting a risk factor for occurrence of posterior superior impingement syndrome. The S-SMI could serve as a diagnostic tool for guidance of sports-specific training, prevention and rehabilitation of shoulder instability.

Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals

BackgroundArthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures. ObjectiveTo determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals. HypothesisUltrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful. Material and methodTwenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope. ResultsNo tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal. DiscussionPreoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed. Level of evidenceIV, cadaver study.

Ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage

To analyze clinical efficiency and intraoperative considerations of ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage. From April 2011 to April 2015, the clinical data of 17 patients diagnosed as ankle impingement syndrome were performed arthroscopy, including 12 males and 5 females, with an average age of 32.4 years (ranging from 22 to 47). Ankle arthroscopy cleaning were carried out according to clinical symptoms and radiological imaging, crashed part were cleaned too. Non steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate were used as conventional postoperatively treatment. AOFAS score and Ogilvie-Harris score were used to assess preoperative situation and postoperative situation. Intra-operative conditions showed 8 cases with anterior lateral impingement syndromes, 2 cases with anterior medial impingement syndromes, 2 cases with posterior impingement syndromes and 3 cases combined with anterior and posterior impingement syndromes. Distal bundle of anterior tibiofibular ligament, anterior talusfibular ligament and synovial tissue and scar tissue were cleared up during operation. Four patients were combined with concomitant articular cartilage injury, and damage area were about 1 mm×3 mm to 1.5 mm×4 mm. Microfracture treatment were performed by 1.2 mm diameter Kirschner wire. All patients were followed up from 8 to 24 months with an average of 14.3 months. AOFAS score increased from 62.3±5.20 preoperatively to 87.6±5.40 postoperatively, Ogilvie-Harris ankle score increased from 6.70±0.98 preoperatively to 12.80±1.21 postoperatively. No neurovascular damage, wound infection or wound healing problem occurred. Ankle swelling were appeared with different degrees, but disappeared at 4 to 8 weeks postoperatively. For ankle impingement syndrome patients, ankle arthroscopy through anterior with posterior passage could effectively clear up bone and soft tissue impingement. Postoperatively non-steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate could effectively relieve ankle pain and swollen and achieve good therapeutic effect.

Ankle impingement.

Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

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

Posterior impingement syndrome of the ankle

Posterior impingement syndrome of the ankle

Posterior Arthroscopic Subtalar Arthrodesis.

Although subtalar joint arthrodesis may be achieved through open or arthroscopic approaches, we have found that posterior arthroscopic subtalar arthrodesis has technical advantages compared with other approaches. Clinically assess the foot and ankle with regard to remaining motion, previous scarring, and associated deformities, ensuring that no concomitant procedure will be needed in the supine position. Use spinal or general anesthesia. Place the posterolateral portal lateral to the Achilles tendon at the level of the tip of the lateral malleolus, according to the original technique described by van Dijk et al. Place the posteromedial portal medial to the Achilles tendon at the level of the tip of the lateral malleolus. With the help of the shaver, look for the landmarks of the posterior arthroscopy, going from the posterolateral part of the subtalar joint toward the flexor hallucis longus tendon, which is medially located, while exposing the tibiotalar joint. Sometimes an accessory portal, just anterior to the tip of the external malleolus, may be needed to achieve a distraction of the anterior part of the subtalar posterior facet. To perform this concomitant step, which generally is not necessary, use an arthroscopic forceps to insert a 5 by 20-mm autograft or allograft in the subtalar joint. Use two cannulated screws with a 7.3-mm diameter; we prefer stabilization screws to compression screws. Always clean out the posterior compartment of the ankle during the PASTA procedure, as is done during surgical treatment for posterior impingement syndrome, and note that both posterior impingement syndrome and subtalar degenerative changes may thereby be easily addressed through this procedure. A short posterior leg splint is worn for three to ten days, followed by another non-weight-bearing cast for another three weeks. Since the appearance of the original article, a total of forty-one unilateral subtalar joints in twenty-five men and sixteen women, seen between May 2007 and December 2012, with isolated subtalar arthritis or talocalcaneal coalition without any other major hindfoot arthritis were treated by posterior arthroscopic subtalar arthrodesis, and all subtalar joints except for two were considered radiographically fused at the first attempt after an average of 6.7 weeks (range, six to ten weeks).IndicationsContraindicationsPitfalls & Challenges.

Endoscopic treatment of the posterior ankle impingement syndrome on amateur and professional athletes.

To determine whether professional and amateur athletes showed differences in ankle function when treated with endoscopic technique for posterior ankle impingement syndrome, to verify the impact of the presence of associated lesions in clinical evolution and to assess time to return to sport (we hypothesize that time will be the only difference between groups). Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedics Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The satisfaction, time to return to sport, operative time, intraoperative findings and complications were evaluated, and the presence of associated injuries interfering in these results was verified. The preoperative AOFAS score range for the professional group was 62.9 ± 14 preoperatively and 92.3 ± 7.7 postoperatively, and for the amateur group was 67.9 ± 19.7 and 94 ± 9.3. The satisfaction was excellent or good in 94 % of all cases and fair in 6%. The average time of surgery was 48.3 + 25 min. Bone involvement was present in 100% of cases and complications in three cases. Time to return to sports was similar (n.s.) in both groups, and the mean time was 15.6 ± 13.7 and 16.3 ± 9 weeks, respectively. No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Athletes showed mainly good and excellent results and low complication rate. The presence of associated injuries did not significantly influence the results. With these results, the high-level athlete can better programme their surgeries so they can fully recover and perform better in the most important competitions. Level III.

Anatomical characteristics of the flexor digitorum accessorius longus muscle and their relevance to tarsal tunnel syndrome a systematic review.

Clinical and cadaver studies have reported that supernumerary muscles could be the etiology of a variety of pathologic disorders, such as posterior impingement syndrome, tarsal tunnel syndrome (TTS), and flexor hallucis longus tenosynovitis. We describe a unique variant of the flexor digitorum accessorius longus (FDAL) muscle as an apparent cause of TTS, functioning as an independent flexor of the second toe, which has not been described in the literature. In addition to this case report, a systematic review was performed of TTS caused by the FDAL muscle. A targeted search of PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and Web of Science identified full-text papers that fulfilled the inclusion and exclusion criteria. Twenty-nine papers were identified for inclusion in the systematic review: 12 clinical papers of TTS caused by the FDAL muscle and 17 cadaver-based papers. Clinicians often do not include the FDAL muscle in the differential diagnosis of TTS. This literature review suggests that the FDAL is an important muscle in terms of its functional and clinical significance. Knowledge of this muscle, its anatomical location and variations, and its magnetic resonance imaging characteristics may help clinicians make an accurate differential diagnosis.

Increased delivery stride length places greater loads on the ankle joint in elite male cricket fast bowlers

The purpose of this study was to investigate the effect stride length has on ankle biomechanics of the leading leg with reference to the potential risk of injury in cricket fast bowlers. Ankle joint kinematic and kinetic data were collected from 51 male fast bowlers during the stance phase of the final delivery stride. The bowling cohort comprised national under-19, first class and international-level athletes. Bowlers were placed into either Short, Average or Long groups based on final stride length, allowing statistical differences to be measured. A multivariate analysis of variance with a Bonferroni post-hoc correction (α = 0.05) revealed significant differences between peak plantarflexion angles (Short-Long P = 0.005, Average and Long P = 0.04) and negative joint work (Average-Long P = 0.026). This study highlighted that during fast bowling the ankle joint of the leading leg experiences high forces under wide ranges of movement. As stride length increases, greater amounts of negative work and plantarflexion are experienced. These increases place greater loads on the ankle joint and move the foot into positions that make it more susceptible to injuries such as posterior impingement syndrome.