SLR - November 2023 - Ngo
Title: Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle ImpingementReference: Mercer NP, Samsonov AP, Dankert JF, et al. Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement. Arthrosc Sports Med Rehabil. 2022;4(2)
Level of Evidence: Level 4
Scientific Literature Review
Reviewed By: Tiffany Ngo
Residency Program: New York College of Podiatric Medicine
Podiatric Relevance: In-office needle arthroscopy is a new technique that is not well-known in podiatric surgery. This technique also helps in offsetting the cost of anesthesia and full operating suite, which is more favorable to both patients and surgeons. The author hypothesized that IONA would give improved overall satisfaction with clinical outcomes similar to traditional arthroscopy for treatment of posterior ankle impingement syndrome (PAIS).
Methods: Retrospectively reviewing patients undergoing IONA with minimum of 12-month follow-up for PAIS after exhausted conservative treatment > 3 months. Patients must be > 18 years of age and had clinical/physical history and imaging consistent with PAIS. At final follow-up visit, clinical outcome measures by FAOS and PROMIS, patient’s satisfaction with IONA measures by 5-point Likert scale
Results:
- 10 patients were identified (4M:6F), mean age: 41.9.
- Mean follow-up time: 13.3 months.
- All aspect of FAOS scores (symptoms, pain, ADL, sports, QoL) improved post-op.
- Means PROMIS pain intensity T-score significantly decreased from 57.5 pre-op to 49.5 at final visit. Mean PROMIS pain interference T-score significantly decreased from 69.0 pre-op to 63.1 at final visit.
- All patients returned to regular work activity, mean time to return to work was ~3.4 days (range, 0-14 days)
- All patients returned to sport activities with 5 over 7 patients (71%) returning to pre-PAIS play level, mean time to return to sport was 4.8 weeks (range, 2-14 weeks).
- 9/10 patients reported overall positive experience for IONA since they got to see their procedure in real time and aided in their understanding of pathology. 8/10 patients reported highest rating for preferring to undergo the procedure in office setting. Mean satisfaction was 4.7/5. All patients expressed willingness to undergo the same procedure in the future.
- No complication in this patient cohort.
Conclusion: Authors concluded that IONA treatment of PAIS yields good results in pain reduction, low complication rate, and excellent PROMIS. The outcomes of this small case series are promising and may translate to similar results in larger cohort studies in the future. In non-complex complex pathologies, IONA could be utilized to save OR time, offsetting the cost for patients, and reduce the risk of anesthesia exposure to patient. However, more studies should be conducted with larger populations and longer follow-up time to assess long-term outcomes, complication, and recurrence rate. It is a relatively new technique, and the patients need to be fully informed about the procedure as well as made aware of the limitation regarding this technique. From this article, it seems promising, however, until there are more studies, I believe traditional techniques would still be preferred amongst surgeons and patients.