Arthroscopy ‘preferable’ for recalcitrant posttraumatic ankle impingement syndrome
MedWire News: A minimally invasive technique can be used to successfully treat patients with posttraumatic ankle impingement syndrome, show study findings published in the journal Foot and Ankle Surgery.
"Ankle arthroscopy with resection of hypertrophic synovium and fibrous bands (type I) or tibial spurs (types II and III injuries) after an ankle sprain have proven to be a reliable therapy for a posttraumatic impingement syndrome of the ankle that does not respond to conservative treatment," reports author Heino Arnold (Orthopädisches Zentrum Fichtelgebirge, Rehau, Germany).
The study followed-up 312 patients aged an average of 38 years whose ankles had been assessed on X-ray using Scranton's score. Twenty-two patients had grade I syndrome, defined as pain associated with soft tissue changes or a tibial spur of less than 3 mm. Grade II changes, consisting of a larger spur were found in seven patients, while three patients had grade III changes, defined as talar spurs or spur fragmentation.
The patients had not responded to 3 months of conservative treatment consisting of heel lifting, nonsteroidal drugs, and physiotherapy.
The patients were assessed before, and an average of 49 months after, surgery using the West Point Ankle Score, which assesses both subjective and objective characteristics including pain, swelling, motion, and gait.
The postoperative West Point Ankle Score was an average 86 out of a possible 100 points, an increase on the pre-operative average score of 64 points.
Overall, 26 of the patients scored 80 or above after surgery, indicating a good or excellent outcome. Five patients rated their postoperative score as fair and one patient considered their result bad; these patients had experienced an ankle fracture or required additional surgery.
Importantly, patients were able to continue with everyday activities without further impingement or swelling, and reported improvements in their pain-free range of motion. Three patients had minor short-term complications.
"Our study confirms that arthroscopic surgery is the preferable therapy for an ankle impingement grades I-III (Scranton) that does not respond to conservative treatment," concludes Arnold. "This way of treatment is characterized by low morbidity and good to excellent results in most cases."
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By Lynda Williams