SLR- March 2014- Jessica Lickiss
Reference: Smyth; NA Murawski; CD. Levine; DS. Kennedy; JG. Hindfoot Arthroscopic Surgery for Posterior Ankle Impingement: A Systematic surgical Approach and Case Series. Am J Sports Med.2013 Aug;41(8):1869-7.
Scientific Literature Review
Reviewed by: Jessica Lickiss, DPMResidency Program: Inova Fairfax Residency Program
Podiatric Relevance: This article presents a systematic approach to identifying anatomy and abnormalities encountered during hindfoot arthroscopy. It also provides evidence that hindfoot arthroscopy may be a safe and effective approach for treating posterior ankle impingement syndrome.
Methods: The authors created a systematic surgical approach that divides the hindfoot into quadrants based upon the intermalleolar ligament. The ligament is able to divide superior/inferior and medial/lateral with its position. All portals were placed in the same fashion using the borders of the Achilles tendon, regardless of pathology. Twenty-two patients with posterior ankle impingement, who failed non-operative treatment and a follow up of 25 months, were included in the case series portion of the study. Outcomes were based upon questionnaires and the patient’s ability to return to their previous level of activity.
Results: Mean Foot and Ankle Outcome Score (FAOS) improved from 59 pre-operatively to 86 post-operatively. All patients returned to their previous level of activity,with a mean return time of 12 weeks. Two post operative complications were experienced and included a wound infection and dysesthesia of the deep peroneal nerve. This is the first paper to report peroneal nerve injury as a result of hindfoot arthroscopy as opposed to pre-operative anesthesia causing the injury.
Conclusions: Hindfoot arthroscopy is a safe and effective treatment for patients with ankle impingement. Arthroscopy, as opposed to open technique, may allow patients to return to their activities sooner. The author’s surgical technique allows for easy identification of important anatomical structures, and creates a systematic approach to treating all posterior ankle pathology. This allows surgeons to have good outcomes and low complication rates. The study is limited by size, retrospective analysis, and heterogeneous group of patient injuries.The strengths include a systematic surgical approach to all pathology, and long follow up.