SLR - May 2022 - Won Ho Ryan Chang, DPM
Reference: Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-Office Needle Arthroscopy for the Treatment of Anterior Ankle Impingement Yields High Patient Satisfaction with High Rates of Return to Work and Sport. Arthroscopy. 2022 Apr;38(4):1302-1311.Level of Evidence: IV Scientific Literature Review
Reviewed By: Won Ho Ryan Chang, DPM
Residency Program: NYCPM/Metropolitan Hospital – New York, NY
Podiatric Relevance: The need for faster recovery times has prompted surgeons to seek alternatives to traditional arthroscopic treatment in an effort to reduce local soft-tissue trauma and thus facilitate earlier mobilization and earlier return to sports related activities.
Methods: After approval from an institutional review board, a prospectively collected database of 31 patients undergoing IONA for the treatment of anterior ankle impingement between January 2019 and January 2021 was retrospectively reviewed. Inclusion criteria for this study were patients ≥18 years of age, clinical history, physical examination, radiographic imaging, and magnetic resonance imaging (MRI) findings consistent with anterior ankle impingement for which each patient underwent IONA and had a minimum of 12-month follow-up.
Results:
Patient Demographics
A total of 33 patients who underwent IONA for the treatment of anterior ankle impingement in the office setting were identified. Thirty-one patients were included in this study, 18 male and 13 female, with two removed due to less than 12-month follow-up. The mean age of 41.7 ± 15.5 years and mean BMI of 27.3 ± 5.7. The mean follow-up time was 15.5 ± 4.9 months. Six patients were treated for primary anterior ankle impingement with no previous ipsilateral surgery and 25 patients had a history of previous ipsilateral surgery. The mean time since previous surgery to IONA procedure was 35.3 ± 35.7 months. The mean Scranton and McDermott classification grade8 was 1.4 ± 0.6.
Return to Activities
All patients who worked before the IONA procedure returned to work activity. There were 20 patients (65 percent) who were working before IONA. All 20 (100 percent) patients working were able to return to work. The median time to return to work was 1.98 days (range, 0 to 14 days). There were 27 patients who participated in sports activity before the IONA procedure. Of those, 26 patients (96 percent) returned to their sports activities. The mean time to return to sports was 3.9 weeks (range 1-12 weeks).
Conclusions: The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.