632042
research-article2016
FAIXXX10.1177/1071100716632042Foot & Ankle InternationalBin et al
Article
Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome
Foot & Ankle International® 1–6 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716632042 fai.sagepub.com
Bin Song, MM1, Changchuan Li, MD2, Zhong Chen, MM1, Rui Yang, MD1, Jingyi Hou, MD1, Weiquan Tan, MBBS1, and Weiping Li, MD1
Abstract Background: 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. Methods: 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). 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. Conclusions: 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 of Evidence: Level IV, retrospective case series. Keywords: ankle impingement syndrome, arthroscopy, surgical approach, postoperative outcome
Introduction Over the years, arthroscopy and endoscopy have developed quickly as the techniques of choice for treatment of ankle and hindfoot lesions. In 1997, Marumoto and Ferkel first described and advocated the use of a posterolateral portal in combination with standard anterior arthroscopy to perform the excision of the os trigonum.9 Since then, researchers have reported various techniques of hindfoot arthroscopy.2,7,13,18,19 Van Dijk first described a 2-portal endoscopic approach of the hindfoot with the patient in the prone position16 and declared that they could visualize and
surgically treat the lesions of the posterior ankle joint and subtalar joint via the 2 posterior approaches. 1
Department of Sports Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China 2 Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China Corresponding Author: Li Weiping, XX, Department of Sports Medicine, Sun Yat-sen Memorial Hospital, No. 107 on Yanjiangxi Road, 510120, Yuexiu District, Guangzhou, Guangdong, China. Email: [email protected]
Downloaded from fai.sagepub.com at WESTERN MICHIGAN UNIVERSITY on February 24, 2016
2
Foot & Ankle International
However, the method was challenged by the posterior and anterior ankle impingement syndrome, which needed debridement of both anterior ankle and posterior ankle. It troubled the surgeons how to surgically treat the lesions of both anterior and posterior ankle in one operation. Traditional practices require repositioning of the patient, and thus repeated prep and drape. We wondered if this problem could be solved by a novel body position or surgical approaches. Our study aimed to present an innovative method to treat the lesions of both anterior and posterior ankle with the patient in the same position. We combined the standard anterior approaches and dual posterolateral approaches arthroscopically with the patient in a recumbent position to treat both anterior and posterior lesions.
Methods From January 2013 to January 2015, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. All the patients had tenderness of the anterior ankle and posterior ankle, which could be exacerbated by extreme passive dorsiflexion and plantarflexion of the ankle. Imaging studies showed osteophytes in the anterior ankle or a large os trigonum in all patients. The patients were divided into the conventional group and the modified group, according to the surgical approaches used in the operation. In the conventional group, the operation was performed via the standard anteromedial-anterolateral and posteromedial-posterolateral approaches, whereas in the modified group, the operation was performed via the standard anterior approaches combined with dual posterolateral approaches. Thirteen consecutive patients were included in the conventional group, and the following 15 consecutive patients who were treated after October 1, 2013, were included in the modified group. The modified group included 10 men and 5 women. Six cases were in the left ankle and 9 in the right. The patients were aged between 23 and 64 years (48 on average). Thirteen patients had decreased range of joint motion. The control group included 10 men and 3 women. Five cases were in the left ankle and 8 in the right. The patients were aged between 18 and 58 years (46 on average). Ten patients had decreased range of motion. There was no significant difference in preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) score, dorsiflexion, and plantar flexion between the conventional group and the modified group (Table 1). The average follow-up was 16 months (range 6-24 months).
Surgical Techniques The patient received epidural anesthesia or lumbar spinal anesthesia and placed in the supine position with a thigh tourniquet. First, standard anteromedial and anterolateral
Table 1. Preoperative and Postoperative AOFAS Score, VAS Score, and Range of Motion in the Conventional Group and the Modified Group. Conventional
Modified
61.2±9.4 94.1±5.1
research-article2016
FAIXXX10.1177/1071100716632042Foot & Ankle InternationalBin et al
Article
Combined Anterior and Dual Posterolateral Approaches for Ankle Arthroscopy for Posterior and Anterior Ankle Impingement Syndrome
Foot & Ankle International® 1–6 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716632042 fai.sagepub.com
Bin Song, MM1, Changchuan Li, MD2, Zhong Chen, MM1, Rui Yang, MD1, Jingyi Hou, MD1, Weiquan Tan, MBBS1, and Weiping Li, MD1
Abstract Background: 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. Methods: 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). 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. Conclusions: 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 of Evidence: Level IV, retrospective case series. Keywords: ankle impingement syndrome, arthroscopy, surgical approach, postoperative outcome
Introduction Over the years, arthroscopy and endoscopy have developed quickly as the techniques of choice for treatment of ankle and hindfoot lesions. In 1997, Marumoto and Ferkel first described and advocated the use of a posterolateral portal in combination with standard anterior arthroscopy to perform the excision of the os trigonum.9 Since then, researchers have reported various techniques of hindfoot arthroscopy.2,7,13,18,19 Van Dijk first described a 2-portal endoscopic approach of the hindfoot with the patient in the prone position16 and declared that they could visualize and
surgically treat the lesions of the posterior ankle joint and subtalar joint via the 2 posterior approaches. 1
Department of Sports Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China 2 Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China Corresponding Author: Li Weiping, XX, Department of Sports Medicine, Sun Yat-sen Memorial Hospital, No. 107 on Yanjiangxi Road, 510120, Yuexiu District, Guangzhou, Guangdong, China. Email: [email protected]
Downloaded from fai.sagepub.com at WESTERN MICHIGAN UNIVERSITY on February 24, 2016
2
Foot & Ankle International
However, the method was challenged by the posterior and anterior ankle impingement syndrome, which needed debridement of both anterior ankle and posterior ankle. It troubled the surgeons how to surgically treat the lesions of both anterior and posterior ankle in one operation. Traditional practices require repositioning of the patient, and thus repeated prep and drape. We wondered if this problem could be solved by a novel body position or surgical approaches. Our study aimed to present an innovative method to treat the lesions of both anterior and posterior ankle with the patient in the same position. We combined the standard anterior approaches and dual posterolateral approaches arthroscopically with the patient in a recumbent position to treat both anterior and posterior lesions.
Methods From January 2013 to January 2015, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. All the patients had tenderness of the anterior ankle and posterior ankle, which could be exacerbated by extreme passive dorsiflexion and plantarflexion of the ankle. Imaging studies showed osteophytes in the anterior ankle or a large os trigonum in all patients. The patients were divided into the conventional group and the modified group, according to the surgical approaches used in the operation. In the conventional group, the operation was performed via the standard anteromedial-anterolateral and posteromedial-posterolateral approaches, whereas in the modified group, the operation was performed via the standard anterior approaches combined with dual posterolateral approaches. Thirteen consecutive patients were included in the conventional group, and the following 15 consecutive patients who were treated after October 1, 2013, were included in the modified group. The modified group included 10 men and 5 women. Six cases were in the left ankle and 9 in the right. The patients were aged between 23 and 64 years (48 on average). Thirteen patients had decreased range of joint motion. The control group included 10 men and 3 women. Five cases were in the left ankle and 8 in the right. The patients were aged between 18 and 58 years (46 on average). Ten patients had decreased range of motion. There was no significant difference in preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) score, dorsiflexion, and plantar flexion between the conventional group and the modified group (Table 1). The average follow-up was 16 months (range 6-24 months).
Surgical Techniques The patient received epidural anesthesia or lumbar spinal anesthesia and placed in the supine position with a thigh tourniquet. First, standard anteromedial and anterolateral
Table 1. Preoperative and Postoperative AOFAS Score, VAS Score, and Range of Motion in the Conventional Group and the Modified Group. Conventional
Modified
61.2±9.4 94.1±5.1
