Posttraumatic Ankle Pain Research Articles

Atelocollagen-Induced Chondrogenesis Versus Microfracture Alone for Osteochondral Lesions of the Talus: Surgical Technique and a 1-Year Clinical Outcome Study.

Osteochondral lesions of the talus (OLTs) are a common cause of post-traumatic ankle pain and disability. Atelocollagen-induced chondrogenesis (ACIC) aims to encourage the development of hyaline cartilage, which is biomechanically superior to fibrocartilage. This single-center, retrospective database study assessed patients who underwent arthroscopic microfracture with or without atelocollagen scaffold augmentation for OLT. Between 2010 and 2019, 87 patients underwent microfracture only and 31 patients underwent ACIC. Propensity score matching was used to match the ACIC group in a 1:2 ratio to a corresponding microfracture-only group using logistic regression. American Orthopaedic Foot & Ankle Society (AOFAS) scores, 100-mm Visual Analog Scale (VAS), Short Form-36 (SF-36), and satisfaction were assessed at preoperative, 3-, 6-, and 12-month intervals. There were no differences in baseline characteristics between groups after matching (P > .05). Both groups had similar improvements to VAS, AOFAS, and SF-36 scores up to 12 months (P > .05). Both groups had significant 1-year improvements to physical functioning, physical limitations in usual role activities, pain, and social functioning domains, but the ACIC group additionally had significant improvements to general health, vitality, and mental health. Patients in the ACIC group were also more satisfied than the microfracture group at all time points. Patients with OLTs who underwent ACIC reported superior satisfaction and improvements to quality of life, although clinical outcomes were similar to those who underwent microfracture alone at 1 year.Level of Evidence: Level III: Cohort study.

ANKLE ARTHROSCOPY IN POST TRAUMATIC ANKLE PAIN

Background: The clinical use of ankle arthroscopy for diagnosis and treatment of foot and ankle disorders has increased over the last few decades, it may seem novel to those unfamiliar to this technique. The recent advances in the equipment as well as sound knowledge of the anatomy of the portals required for safe scope insertion have made a possible number of diagnostic and therapeutic procedures. Aim: to give a good, efficient and radical minimal invasive solution to the chronic post traumatic ankle pain, Also we can perform an arthroscopic assisted ankle arthrodesis. Methods: This study was conducted on 25 patients with post traumatic ankle pain. They were being collected from the orthopedic department of Benha University and orthopedic department of Railway hospital. Results: Majority of cases were males by 72%, Mean ± SD of age was 37.52 ± 11.87 and majority of cases had right side lesion by 72%. There was highly statistically significant difference between preoperative and postoperative regarding diagnosis score with better score postoperative. 80% of cases had no complications, 4% had Subchonfrs sclerosis, 4% had RSD well early, and 4% had Fair mild pain + mild swelling. Conclusion: Arthroscopic management of post-traumatic ankle pain was indicated if the history and clinical examination are suggestive, arthroscopy proved to be effective for confirming the diagnosis and for treatment.

Clinical presentation and surgical treatment of distal fibular non-union with talus chondral lesions in a pediatric patient: a case report

BackgroundIn children, fracture non-union is uncommon yet, curiously, non-union of distal fibula fractures are rarely reported. Historically, the most common treatment of a lateral malleolus fracture after an ankle sprain is conservative, which usually leads to fracture union. However, even in clinically stable ankles, subsequent pain arising from fracture site could suggest non-union, thereby necessitating reexamination and possible secondary treatment.Case presentationWe report the case of an 8-year-old girl with an epiphyseal distal fibula fracture complicated with a symptomatic non-union associated with the chondral flap of the talar dome after conservative treatment. Surgical excision of the fragment and chondroplasty was performed and resulted in an excellent clinical outcome.ConclusionThis case report illustrates the necessity of particularly meticulous evaluation of pediatric post-traumatic ankle pain. Surgical treatment as well as talar chondral evaluation should be taken into consideration in the treatment of pediatric distal fibular nonunion.

Magnetic resonance imaging of ankle ligaments: A pictorial essay.

Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.

Ultrasonographic Findings and Clinical Characteristics of Two Patients With Talar Osteochondritis Dissecans

Osteochondritis dissecans of the talus is a potential cause of chronic post-traumatic ankle pain. Soft-tissue ultrasound (US) traditionally is rarely used to detect intra-articular lesions. With two case reports, we suggest that a unique soft-tissue US picture, large amount of ankle joint effusion without ligament injury and no obvious bone fracture on radiography, should hint the intra-articular pathology. Two patients with chronic ankle pain following sprain received US assessment of the ankle for the initial radiographs, disclosed no bone fracture. The images revealed a large amount of effusion in the ankle joint with no evidence of fracture or extra-articular ligament injury, suggesting intra-articular lesions. Subsequent magnetic resonance imaging studies confirmed the underlying osteochondritis dissecans of talus.

Intra‐articular fibrous band of the ankle: An uncommon cause of post‐traumatic ankle pain

A case of an intra-articular fibrous band of the ankle is presented with emphasis on the MR imaging appearances. This entity is an important but uncommon cause of post-traumatic ankle pain and is well recognized within the arthroscopy literature, but there is little if any documentation of this condition in the imaging literature.

Treatment of Posttraumatic Adhesive Capsulitis of the Ankle: A Case Series

Adhesive capsulitis of the ankle is a challenging diagnostic and therapeutic problem. Limited information concerning diagnosis and treatment is available in the musculoskeletal literature. This study retrospectively reviewed a series of patients treated with corticosteroid injections or arthroscopic debridement of posttraumatic adhesive capsulitis of the ankle. The Foot Function Index was used to assess the final treatment outcomes. Forty-one patients with chronic posttraumatic ankle pain were identified. Five were confirmed to have posttraumatic adhesive capsulitis by arthrogram. Four of the five patients failed to respond to steroid injections and three had arthroscopic surgery. Foot Function Index scores indicated that two of these patients treated with arthroscopic debridement had improved function. Results of small series and information from the literature suggest that intra-articular injection of corticosteroid followed by arthroscopic synovectomy and scar resection can be effective as treatment for posttraumatic adhesive capsulitis of the ankle.

Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography.

This article describes the appearance of the anterolateral recess of the posttraumatic ankle on CT arthrography and clearly shows the benefit of this technique in the diagnosis of soft-tissue impingement. The study was carried out on 44 patients examined by CT arthrography and arthroscopy for chronic, posttraumatic ankle pain. The analysis principally concerned the lateral compartment--in particular, the synovial regularity and the cartilage of the talar dome. Four CT patterns were identified: type 0, uniform filling of the recess with clear limits; type I, intraarticular linear structure outlined by contrast agent; type II, nodular formation in the lateral groove; and type III, irregular appearance of the edges of the lateral groove. Ninety-one percent (10/11) of type II patterns were characterized as meniscoid lesions by arthroscopic examination, 100% (14/14) of type III patterns corresponded to an abundant fibrous reaction, and arthroscopic findings were normal for 100% (2/2) of type 0 patterns and 88% (15/17) of type I patterns. The latter was thus considered as a normal variant outlining the accessory anterior inferior tibiofibular ligament. Type II and III lesions were statistically associated (p = .001) with a chondropathy when time from initial trauma was greater than 22 months. CT arthrography provides evidence of anterolateral soft-tissue impingement--in particular, in type II or III patterns. These lesions are statistically associated with a chondropathy.

Pseudarthrosis of the posterior talar process. A rare cause for chronic ankle discomfort

Summary Lesions of the os trigonum and the posterior talar process must be considered in the differential diagnosis of post-traumatic ankle pain. A 26-year-old soccer player suffered from chronic ankle pain following a forced equinus injury of the left ankle. Non-union following a fracture of posterior talar process was diagnosed and treated after months of ineffective management.

Excision of ununited fractures of the posterior process of the talus: a treatment for chronic posterior ankle pain.

The cases of nine patients with ununited fracture of the posterior process of the talus were reviewed. The most common mechanism of injury was forced plantarflexion. All patients had pain in the posterior ankle region. Common physical findings included tenderness between the lateral malleolus and the Achilles tendon and pain on forced plantarflexion. Of the radiographic imaging modalities used, 99Tc bone scan was found to be the most helpful in diagnosis. All nine patients eventually underwent surgical excision at a mean period of 9.4 months post injury. At average follow-up of 27 months after surgery (range 7-69 months), six of nine patients had good or excellent results with respect to pain relief and return to function. There were two complications of sural neuroma formation, one of which resulted in severe persistent pain after surgery. Based on these findings, we believe the differential diagnosis of chronic posttraumatic ankle pain should include fracture of the posterior process of the talus. Furthermore, excision of an ununited fragment through a lateral approach, taking care to preserve and protect the sural nerve, should lead to the return of painless function in the majority of cases.