Os Trigonum Syndrome or Posterior Ankle Impingement (PAI)

Thirty cases of posterior ankle impingement in 28 patients were treated over a 10-year period (1982–1992). All conditions were caused by forced plantar flexion. An os trigonum or posterior process fracture was demonstrated radiographically in 63% of these cases, and an intact posterior process was demonstrated in 33%. Ten cases were lost to follow-up. Of the remaining 20 cases, in 18 patients 12 (60%) improved with nonoperative treatment; 8 (40%) required operative excision. The results were good to excellent in 7 patients and fair in 1 patient. Operative excision for the treatment of recalcitrant posterior ankle impingement can relieve symptoms and allow a return to full preinjury activities.

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The Anatomical Variations of the Posterolateral Tubercle of Talus in Patients with Posterior Ankle Impingement Syndrome

10.21203/rs.3.rs-140532/v1 ◽

2021 ◽

Author(s):

Heba Kalbouneh ◽

Mohammad Alsalem ◽

Maysoon Bani Hani ◽

Hamzeh Alhusamiah ◽

Yazan Momani ◽

...

Keyword(s):

Anatomical Variations ◽

Ct Imaging ◽

Impingement Syndrome ◽

Common Variant ◽

Ct Scans ◽

Os Trigonum ◽

Anatomical Variants ◽

Ankle Impingement ◽

Posterior Ankle Impingement

Abstract Background: The most important anatomical variations of the posterolateral talar tubercle that can predispose patients to development of posterior ankle impingement syndrome (PAIS) are an os trigonum and Stieda process. The aim of this study was to elucidate the prevalence of different anatomical variants of posterolateral talar tubercle on CT imaging, their prevalence in patients with PAIS, and to evaluate the risk posed by these anatomical variants to PAIS. Methods: 1478 ankle CT scans were retrospectively reviewed for the different anatomical variants of the lateral talar tubercle, the type and size of os trigonum. In addition, these anatomical differences were assessed in a subgroup of patients with PAIS. Results: Normal sized lateral tubercle was found in 46.1%, Stieda’s process in 26.1%, os trigonum in 20.5% and almost absent tubercle in 7.3%. A statistically higher prevalence of Stieda’s process was found in males while os trigonum was higher in females (p<0.05). In patients with PAIS, the most common variant was os trigonum (48.8%), followed by Stieda process (34.1%). Patients with Stieda process were 1.5 times more likely to have PAIS, and patients with os trigonum were 4.4 times more likely to have PAIS. PAIS was observed in 20.8% of patients with os trigonum. Fused forms of os trigonum (by cartilage) and sizes larger than 1cm were associated with a higher risk of occurrence of PAIS (OR 2.10 and OR 1.96 respectively)(p<0.05). Conclusion: Patients with os trigonum, followed by Stieda process were more likely to have PAIS compared to other anatomical variants of lateral talar tubercle.

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Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-003-0465-5 ◽

2004 ◽

Vol 12 (3) ◽

pp. 250-253 ◽

Cited By ~ 29

Author(s):

P. F. Leyvraz ◽

A. Akiki ◽

M. Dutoit ◽

R. Garofalo ◽

E. Mouhsine ◽

...

Keyword(s):

Os Trigonum ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Post Traumatic ◽

Possible Cause

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Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000272 ◽

2019 ◽

Vol 4 (4) ◽

pp. 181-187

Author(s):

Ruben Zwiers ◽

Johannes G G Dobbe ◽

Geert J Streekstra ◽

Leendert Blankevoort ◽

Johannes I Wiegerinck ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Interobserver Reliability ◽

Diagnostic Value ◽

Lateral View ◽

Ct Scans ◽

Ankle Pain ◽

Os Trigonum ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Projection Angle

ObjectivesA standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement.MethodsUsing ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated.ResultsHigh sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found.ConclusionThis study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain.Level of evidenceLevel III

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Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda’s process resection in patients with posterior ankle impingement syndrome: a prospective comparative study

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2021-000619 ◽

2021 ◽

pp. jisakos-2021-000619

Author(s):

Panagiotis D Symeonidis ◽

Emmanouil T Papakostas ◽

Theodorakys Marín Fermín ◽

Maria Tsalidou ◽

Ioannis Terzidis ◽

...

Keyword(s):

Comparative Study ◽

Arthroscopic Treatment ◽

Aofas Score ◽

Level Of Evidence ◽

Os Trigonum ◽

Persistent Symptoms ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Prospective Comparative Study

ObjectiveTo evaluate the potential differences in American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot Function Index (FFI) at 6-month and 12-month postoperative follow-up of arthroscopic treatment for posterior ankle impingement (PAIS) between os trigonum (OT) and Stieda’s process (SP) patients.MethodsThirty consecutive patients (32 ankles) treated in our Institution for PAIS with posterior arthroscopy were prospectively enrolled in the study from December 2012 to July 2019. Indications were patients with PAIS with persistent symptoms following conservative management. Exclusion criteria were the coexistence of concomitant pathologies and patients who underwent additional surgical procedures. An independent investigator interviewed and evaluated the patients according to the AOFAS hindfoot score and FFI preoperatively, at 6-month and 12-month follow-up.ResultsExcept for AOFAS scores in the SP group (MD (mean difference) 11.28, p=0.08), patients undergoing arthroscopic treatment for bony PAIS had an overall significant improvement in AOFAS score (OT MD 22.29, p<0.05) and FFI (OT MD −70.07, p<0.05; SP MD −50.96, p<0.05) from their preoperative scores at 6-month follow-up. Similarly, a significant improvement in AOFAS score (OT MD 5.78, p=0.01; SP MD 12.14, p<0.05) and FFI (OT MD −9.36, p=0.04; SP MD −26.43, p<0.05) was observed from the 6-month to 12-month follow-up in all groups. At 6-month follow-up, the OT group had significantly better FFI outcomes (MD −33.57, p=0.04) compared with the SP group. No differences were found by group when comparing AOFAS score and FFI score at 12-month follow-up.ConclusionsWhen comparing patients undergoing OT excision or SP resection, better FFI outcomes were observed in the OT group at 6-month follow-up.Level of evidenceProspective comparative study. Level II.

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Prevalence of Os Trigonum on CT Imaging

Foot & Ankle International ◽

10.1177/1071100717740937 ◽

2017 ◽

Vol 39 (3) ◽

pp. 338-342 ◽

Cited By ~ 11

Author(s):

Ruben Zwiers ◽

Thomas P. A. Baltes ◽

Kim T. M. Opdam ◽

Johannes I. Wiegerinck ◽

C. Niek van Dijk

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Ct Imaging ◽

African Origin ◽

Level Of Evidence ◽

Os Trigonum ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Retrospective Comparative Study

Background: The os trigonum is known as one of the main causes of posterior ankle impingement. In the literature, a wide variation of occurrence has been reported. Methods: All foot and/or ankle computed tomography (CT) scans made between January 2012 and December 2013 were reviewed. CT images were assessed, blinded for patient characteristics, for the presence of an os trigonum, size of the os trigonum, and type of os trigonum. In addition, the shape of the lateral tubercle of the posterior talar process was assessed. Results: A total of 628 patients (1256 ankles) were included. In 32.5% of the patients of the cohort, an os trigonum was present. In 14.3% of these patients, it was present bilaterally. In a subgroup of patients without posterior ankle impingement the prevalence was 30.3%. Of the nonaffected ankles, an os trigonum was present in 23.7%. Patients with posterior ankle impingement were more likely to have an os trigonum (adjusted odds ratio [OR], 1.86). Afro-Caribbean/Surinamese/Central African origin was associated with a lower rate of occurrence of os trigonum (adjusted OR 0.43). In the ankles without an os trigonum, an enlarged lateral tubercle of the posterior talar process was found in 34.9% and 36.5% of the ankles. Conclusion: This study showed that os trigonum is a common accessory bone. With a prevalence of 30.3% in a population of patients with CT imaging of both ankles and 23.7% of the nonaffected ankles, the os trigonum is more common than previously reported. Patients with posterior ankle impingement complaints had a higher prevalence of an os trigonum. In one-third of the patients without an os trigonum, there was an enlarged lateral tubercle of the posterior talar process. Level of Evidence: Level III, retrospective comparative study.

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Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes

Foot & Ankle Orthopaedics ◽

10.1177/2473011420945330 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142094533

Author(s):

Dimitrios Nikolopoulos ◽

George Safos ◽

Konstantinos Moustakas ◽

Neoptolemos Sergides ◽

Petros Safos ◽

...

Keyword(s):

Endoscopic Treatment ◽

Case Series ◽

Activity Level ◽

Ankle Arthroscopy ◽

Level Of Evidence ◽

Os Trigonum ◽

Recreational Athletes ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Posterior Ankle Arthroscopy

Background: The os trigonum (OT)—the most common accessory bone of the foot—although usually asymptomatic, may cause posterior ankle impingement syndrome (PAIS), which may be a severely debilitating problem for recreational or competitive athletes. The aim of the present study was to evaluate effectiveness of posterior ankle arthroscopy and to assess the outcome in the treatment of PAIS secondary to OT impingement or OT fractures within a group of young athletes and their return to previous sports level. Methods: From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. All patients were diagnosed with PAIS due to OT pathology and were operated on endoscopically with resection of the OT. Pre- and postoperative clinical evaluation were performed at 3 months, 1 year, and 2 years based on visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the Foot & Ankle Disability Index (FADI) scores, in a follow-up of at least 2 years. Results: VAS score was significantly improved from an average of 7.5 (5-9) preoperatively to 1.9 (1-3) at 3 months postoperatively and to 0.6 (0-2) and 0.3 (0 -1) at 1 and 2 years postoperatively. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively ( P < .001). Only 5 patients dropped to a lower activity level. There were 5 complications (4 transient). Conclusion: Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. Posterior ankle arthroscopy was an effective treatment and allowed for a prompt return to a high activity level of their athletic performance. Level of Evidence: Level IV, therapeutic study / retrospective case series.

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