Synovial chondromatosis as an etiology of ankle impingement: a case report

Anterior ankle impingement is a common cause of chronic pain in this site and has synovial chondromatosis, albeit rare, as one of its possible etiologies. Both arthroscopic approach and open arthrotomy are reported as therapeutic option, but the few published data showed that the first is believed to bring more advantages. In a recent study, one of the limitations found by the authors was the rareness of this condition in the ankle, and thus the small number of publications on the topic. We present the rare case of synovial chondromatosis of the ankle in a middle-aged man, which was clinically manifested as anterior impingement syndrome and treated arthroscopically, showing an atypical arboriform vascularization pattern. Level of Evidence V; Diagnostic Studies; Expert Opinion.

Outcomes After Arthroscopic Surgery for Anterior Impingement in the Ankle Joint in the General and Athletic Populations: Does Sex Play a Role?

Background: Although anterior ankle impingement is a common pathology within the athletic population, there have been limited data evaluating outcomes of arthroscopic intervention and whether patient sex affects treatment outcomes. Purpose: To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if patient sex affects outcomes. Study Design: Systematic review. Methods: A systematic literature search of the MEDLINE, Embase, and Cochrane databases was performed during August 2019. The following combination of search terms was utilized: “ankle,” “impingement,” “talus,” “osteophyte,” “arthroscopy,” “surgery,” “procedures,” and “treatment.” Two reviewers independently performed data extraction. Results: A total of 28 articles evaluating 1506 patients were included in this systematic review. Among the studies, 60% (17/28) and 14% (4/28) assessed anterolateral and anteromedial impingement, respectively. Good to excellent results were reported after arthroscopy in patients with anterior ankle impingement, with a success rate of 81.04%. All studies that evaluated functional outcomes (16/16; 100%) cited improvements in American Orthopaedic Foot & Ankle Society scale, visual analog scale, and Foot Function Index. The average complication rate was 4.01%, with the most common complications being mild nerve symptoms and superficial infection. The most common concomitant pathologies included synovitis, osteophytes, meniscoid lesions, and anterior inferior tibiofibular ligament injury. Four studies (15%) failed to report sex as a demographic variable. Only 7 (25%) studies included analysis by sex, with 4 (57%) of these demonstrating differences when comparing outcomes by patient sex. When compared with male patients, female patients exhibited higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement. Conclusion: Our systematic review demonstrates that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes, low complication rates, and good return-to-sports rates in both the general and the athletic population. This study also reports a lack of statistical analysis evaluating outcomes comparing male and female populations. The included studies demonstrate that, compared with male patients, female patients have higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement; therefore, particular attention should be paid to addressing such concomitant pathology.

Outcomes Following Arthroscopy for Anterior Impingement in the Ankle Joint: Need for Gender as a Variable in Analysis

Category: Ankle; Arthroscopy Introduction/Purpose: To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if gender affects outcome. Methods: A systematic literature search of the Medline, Embase, and Cochrane databases was performed during June of 2019. The combination of search terms utilized included the following: ankle, impingement, syndrome, talus, compression, osteophyte, arthroscopy, surgery, procedures, and treatment. Two reviewers independently performed data extraction consisting of demographic data, intraoperative arthroscopic data, functional outcome scores, patient satisfaction, complications, return to play, and gender differences. Results: Twenty-eight articles evaluating 1,506 patients were included in this systematic review [Table 1]. Sixty percent and 14% of studies assessed anterolateral and anteromedial impingement, respectively. All studies (16/16, 100%) that evaluated functional outcome reported improvements in AOFAS, VAS, and FFI Scores [Table 2]. The average complication rate was 3.89% [Table 3]. Average return to sport was 8 months. The most common associated pathologies found during arthroscopic evaluation were synovitis, osteophytes, and meniscoid lesions. Four studies (15%) failed to report gender as a demographic variable. Only 5 (17%) studies reported gender analysis, with one demonstrating that male patients had worse outcomes at 6-year follow-up. Conclusion: Our systematic review suggests that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes and low complication rates in the majority of patients. However, current analyses lack outcome evaluations that compare male and female populations. Future studies should perform such assessments to determine whether gender differences play a role in outcomes following arthroscopic intervention. [Table: see text][Table: see text][Table: see text]

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

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.

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

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.