Diagnosis and treatment of anterior ankle impingement: state of the art

2020 ◽  
Vol 5 (5) ◽  
pp. 295-303
Author(s):  
Pedro Diniz ◽  
Duarte André Sousa ◽  
Jorge Pablo Batista ◽  
Nasef Abdelatif ◽  
Helder Pereira
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Ankle Pain ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

scholarly journals Percutaneous Osteoplasty for the Treatment of a Painful Osteochondral Lesion of the Talus: A Case Report and Literature Review

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E743-E748
Author(s):  
Kyung-Hoon Kim
Keyword(s):  
Bone Cement ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
The Body ◽  
Pain Clinic ◽  
Fluoroscopic Guidance ◽  
Ankle Pain ◽  
Computed Tomography Images

An osteochondral lesion of the talus (OLT) is a lesion involving the talar articular cartilage and its subchondral bone. OLT is a known cause of chronic ankle pain after ankle sprains in the active population. The lesion causes deep ankle pain associated with weight-bearing, impaired function, limited range of motion, stiffness, catching, locking, and swelling. There are 2 common patterns of OLTs. Anterolateral talar dome lesions result from inversion and dorsiflexion injuries of the ankle at the area impacting against the fibula. Posteromedial lesions result from inversion, plantar flexion, and external rotation injuries of the ankle at the area impacting against the tibial ceiling of the ankle joint. Early diagnosis of an OLT is particularly important because the tibiotalar joint is exposed to more compressive load per unit area than any other joint in the body. Failure of diagnosis can lead to the evolution of a small, stable lesion into a larger lesion or an unstable fragment, which can result in chronic pain, joint instability, and premature osteoarthritis. A 43-year-old man, with a history of ankle sprain one year previously, visited our pain clinic for continuous right ankle pain after walking or standing for more than 30 minutes. There was a focal tenderness on the posteromedial area of the right talus. Imaging studies revealed a posteromedial OLT classified as having a geode form according to the FOG (fractures, osteonecroses, geodes) radiological classification and categorized as a stage 2a lesion on magnetic resonance imaging. The patient was scheduled for aspiration and osteoplasty with hydroxyapatite under arthroscopic and fluoroscopic guidance. A 26-gauge needle was inserted to infiltrate local anesthetics into the skin over the cyst and ankle joint. An arthroscope was placed into the joint to approach the OLT. The arthroscopic view showed that there was no connection between the OLT and the cyst of the talus body. A 13-gauge bone biopsy needle was inserted into the cyst, and aspiration was performed. Aspirated fluid from the cyst was originally white and clear; however, it changed to a blood-tinged, reddish color due to mixing with the incisional blood. After aspiration, contrast medium was injected, and the shape of the spread was observed. Bone cement comprising hydroxyapatite was injected to fill the bone defect of the cyst. A 1.5 mL volume of cement was injected into the talus under vigilant fluoroscopic and arthroscopic monitoring to prevent its dissemination into the joint. There was no cement leakage into the vessels or articular space. Postoperative fluoroscopy and computed tomography images showed bone cement filling of the defect. In the present case, arthroscopic and fluoroscopic guidance was used for aspiration of an OLT and for performing percutaneous osteoplasty with hydroxyapatite for one defect; this treatment decreased pain upon weight bearing and enabled a return to work without any restrictions one week after the procedure. The purpose of this report was to highlight the presence of OLT in chronic ankle pain and to review its management strategies. Key words: Ankle, bone fracture, cartilage fracture, calcium polyacrylate-hydroxyapatite cement, cementoplasty, endoscopy, osteochondritis dissecans, pain, sprain, talus.

scholarly journals Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

2019 ◽  
Vol 1 (2) ◽  
pp. 45
Author(s):  
Maghrizal Roychan ◽  
Andre Triadi Desnantyo
Keyword(s):  
Ct Scan ◽  
Cartilage Repair ◽  
Osteochondral Lesion ◽  
Operative Therapy ◽  
Cartilage Regeneration ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Talar Dome ◽  
Operative Techniques ◽  
Reduced Space

ABSTRAKPenyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar. Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak. Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana OLT bervariasi. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi nonoperatif biasanya berupa terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan dalam keluhan simtomatisnya setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Tehnik operatif ini dapat dikategorikan menjadi cartilage repair, cartilage regeneration dan cartilage replacement techniques.Kata kunci: osteochondral lesion of the talus, patofisiologi, tatalaksanaABSTRACTOsteochondral Lesion of the Talus (OLT) is an abnormality in the talus bone in the subchondral layer in the form of osteochondral lesions in the talar dome with consequent abnormalities in the talar joint cartilage. Patients usually come to a health care provider with nonspecific complaints and with symptoms such as pain in the ankles, swelling and reduced space for movement. The diagnosis can be made with a history, physical examination and simple investigations such as X-rays and sophisticated investigations such as CT-Scan and MRI. The management of OLT varies. The management of OLT depends on the stage of the lesion, its chronicity, and the accompanying symptomatic complaints. Patients with acute and non-displaced symptomatic complaints are often given nonoperative therapy usually in the form of conservative therapy with immobilization. Lesions that are unsuccessful or show no improvement in symptomatic complaints after 3 to 6 months, and lesions with displacement can be planned for operative therapy. There are several types of operative techniques that can be done to cure OLT. These operative techniques can be categorized into cartilage repair, cartilage regeneration and cartilage replacement techniques. Keywords: osteochondral lesion of the talus, patophysiology, treatment

Arthroscopic Treatment of Anterior Ankle Impingement Syndrome in Dancers

2005 ◽  
Vol 26 (11) ◽  
pp. 908-912 ◽  
Author(s):  
Aneel Nihal ◽  
Donald J. Rose ◽  
Elly Trepman
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Case Series ◽  
Scar Tissue ◽  
Nonoperative Treatment ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Dance Performance ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

Background: The purpose of this study was to evaluate the results of arthroscopic treatment of anterior bony and soft-tissue impingement of the ankle in elite dancers. Methods: The study is a case series retrospectively reviewed. In the period between 1990 and 1999, 11 elite dancers (12 ankles) had ankle arthroscopy after a diagnosis of anterior ankle impingement that markedly interfered with their dancing. Initial nonoperative treatment failed in all subjects. Previous ankle trauma was noted in all subjects. There were seven women and four men (average age 28 years). Tibiotalar exostoses were radiographically noted in six ankles. Standard anteromedial and anterolateral arthroscopic portals and instrumentation were used for resection of bone spurs and debridement of impinging soft tissues. Patients were nonweightbearing for 5 days after surgery and had postoperative physiotherapy. Results: Nine dancers returned to full dance activity at an average of 7 weeks after surgery. One patient did not return to dance performance because of concurrent unrelated orthopaedic problems, but he resumed work as a dance teacher; he developed a recurrent anterior tibial spur that was successfully resected at a second arthroscopy 9 years later. Another dancer developed postoperative scar-tissue impingement and stiffness; she had a repeat arthroscopy 4 months after the initial procedure and subsequently returned to dance performance. All patients eventually had marked postoperative improvement in pain relief and dance performance. Conclusions: Arthroscopic debridement is an effective method for the treatment of bony and soft-tissue anterior ankle impingement syndrome in dancers and has minimal morbidity.

Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Cartilage ◽  
2020 ◽  
pp. 194760352095940
Author(s):  
Arnd F. Viehöfer ◽  
Fabio Casari ◽  
Felix W.A. Waibel ◽  
Silvan Beeler ◽  
Florian B. Imhoff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pearson Correlation ◽  
Osteochondral Lesions ◽  
Duration Of Symptoms ◽  
Ankle Impingement ◽  
Increased Risk ◽  
Patient Reported ◽  
Specific Factors ◽  
Anterior Ankle Impingement

Objective To determine potential predictive associations between patient-/lesion-specific factors, clinical outcome and anterior ankle impingement in patients that underwent isolated autologous matrix-induced chondrogenesis (AMIC) for an osteochondral lesion of the talus (OLT). Design Thirty-five patients with a mean age of 34.7 ± 15 years who underwent isolated cartilage repair with AMIC for OLTs were evaluated at a mean follow-up of 4.5 ± 1.9 years. Patients completed AOFAS (American Orthopaedic Foot and Ankle Society) scores at final follow-up, as well as Tegner scores at final follow-up and retrospectively for preinjury and presurgery time points. Pearson correlation and multivariate regression models were used to distinguish associations between patient-/lesion-specific factors, the need for subsequent surgery due to anterior ankle impingement and patient-reported outcomes. Results At final follow-up, AOFAS and Tegner scores averaged 92.6 ± 8.3 and 5.1 ± 1.8, respectively. Both body mass index (BMI) and duration of symptoms were independent predictors for postoperative AOFAS and Δ preinjury to postsurgery Tegner with positive smoking status showing a trend toward worse AOFAS scores, but this did not reach statistical significance ( P = 0.054). Nine patients (25.7%) required subsequent surgery due to anterior ankle impingement. Smoking was the only factor that showed significant correlation with postoperative anterior ankle impingement with an odds ratio of 10.61 when adjusted for BMI and duration of symptoms (95% CI, 1.04-108.57; P = 0.047). Conclusion In particular, patients with normal BMI and chronic symptoms benefit from AMIC for the treatment of OLTs. Conversely, smoking cessation should be considered before AMIC due to the increased risk of subsequent surgery and possibly worse clinical outcome seen in active smokers.

Revisiting the Prevalence of Associated Copathologies in Chronic Lateral Ankle Instability: Are There Any Predictors of Outcome?

2018 ◽  
Vol 12 (4) ◽  
pp. 311-315 ◽  
Author(s):  
Ibukunoluwa Araoye ◽  
Zachariah Pinter ◽  
Sung Lee ◽  
Cesar De Cesar Netto ◽  
Parke Hudson ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Reoperation Rate ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Ankle Impingement ◽  
Ankle Ligament ◽  
Ligament Instability ◽  
Lateral Ankle Ligament

Background: Multiple ankle pathologies have been found to coexist with chronic lateral ankle ligament instability, but their prevalence varies widely in the literature. The purpose of this study is to reexamine the prevalence of these associated pathologies and to determine their impact on reoperation rate. Methods: We retrospectively reviewed 382 cases of lateral ankle ligament repair/reconstruction between June 2006 and November 2016. Patient charts and radiograph reports were examined for the presence of any associated foot and ankle pathologies as well as clinical course. The effect of copathologies on reoperation rate was examined using binary logistic regression and the χ2 test. Results: We included a total of 99 cases. Copathologies included peroneal pathology (75/99, 75.8%), ankle impingement (40/99, 40.4%), and osteochondral lesion of the talus (17/99, 17.2%); 36.4% (36/99) had a low-lying muscle belly of peroneus brevis. The total reoperation rate was 12/92 (13.1%). It was lower in cases with peroneal pathology (8.7% vs 27.5%, P = .032). Conclusion: Peroneal pathology, ankle impingement, and osteochondral lesions were the most common associated copathologies in surgical patients with chronic lateral ankle ligament instability. The presence of peroneal pathology may lead to fewer reoperations, possibly as a result of a more comprehensive first-time surgical approach. Level of Evidence: Level III: Retrospective cohort

scholarly journals Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement

2016 ◽  
Vol 7 (3) ◽  
pp. 200-206 ◽  
Author(s):  
Ashish Devgan ◽  
Rajesh Rohilla ◽  
Milind Tanwar ◽  
Aditya Jain ◽  
Karan Siwach ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Soft Tissue ◽  
Arthroscopic Debridement ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

scholarly journals New Perspectives of Osteochondral Lesion of the Talus

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jin Woo Lee
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Surgical Treatment ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Small Lesion ◽  
Osteochondral Autograft

Osteochondral lesions of the talus(OLT) are the most common articular cartilage defects in the ankle and may cause disability as a result of chronic pain and limited weight-bearing capacity. Numerous treatment strategies for symptomatic OLT have advanced significantly over the past decades. OLT are often managed conservatively for an initial stage before the surgical treatment. However, the conservative management determined solely on symptomatology, and not on the physiological healing. A systematic review for the treatment of OLT demonstrated a 45% success rate of non-operative management. Surgical treatment of OLT is reserved for symptomatic focal lesions that fail to respond to conservative treatments. There are three major operative strategies for OLT, reparative, replacement and regenerative manners. For the reparative modality, arthroscopic bone marrow stimulation(BMS) is widely regarded as the first-line treatment for OLT, as it is a technically undemanding, cost-effective, and minimally invasive procedure with low rates of complication and postoperative pain. Small lesion (<15 mm in diameter or <150mm2 in size) is the ideal candidate for BMS supported by several literatures. And a study reported the long-term follow-up study to date at 8-20 years after BMS in which 78% of patients had an excellent or good functional outcome score. As a replacement strategy, autologous osteochondral transplantation(AOT) is often indicated for symptomatic large, cystic lesions, including those that have failed previous reparative procedures, such as BMS. Osteochondral autograft transfer carries the inherent advantage over osteochondral allograft of being from the host with fresh viable cartilage, most commonly harvested from the ipsilateral knee. Clinical studies have found favorable results with osteochondral autograft techniques, including a recent systematic review of clinical outcomes at mid-term follow-up demonstrating excellent or good outcomes in 87% of patients. In recent years, Scaffold-based regenerative techniques are getting more attention. Matrix-associated chondrocyte implantation(MACI) is a 2-step procedure in which culture-expanded autologous chondrocytes are seeded on a scaffold, which is then secured in the OLT. More recently, 1-step procedures have been developed in which scaffolds and/or orthobiologics, including bone marrow aspirate concentrate(BMAC) and platelet-rich plasma(PRP), and hyaluronic acid(HA) have been used to augment microfracture with the intention of overcoming the 2-step procedures while concurrently promoting chondrogenic differentiation of endogenous stem cells. Matrix-augmented BMS is one such technique that has been reported with good results in case series. In the future, an advanced strategy for tissue engineering with gene therapy may influence the quality of integration and longevity in treatment of OLT.

scholarly journals ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Adam Saloom ◽  
Nick Purcell ◽  
Matthew Ruhe ◽  
Jorge Gomez ◽  
Jonathan Santana ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Prospective Study ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Weight Bearing ◽  
Return To Sport ◽  
Time To Surgery ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

scholarly journals A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Alessandro Casiraghi ◽  
Claudio Galante ◽  
Marco Domenicucci ◽  
Stefano Cattaneo ◽  
Andrea Achille Spreafico ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Articular Surface ◽  
Osteochondral Lesion ◽  
Hip Dislocation ◽  
Fracture Dislocation ◽  
Osteochondral Lesions ◽  
Femoral Head Fracture ◽  
Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

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