J Korean Foot Ankle Soc.  2018 Mar;22(1):26-31. 10.14193/jkfas.2018.22.1.26.

Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula)

• Kim ES
• Lee CR
• Kim YJ
• Roh SM
• Park JK
• Gwak HC
• Jung SG

• KMID: 2407372
• DOI: http://doi.org/10.14193/jkfas.2018.22.1.26

Abstract

PURPOSE
The purpose of this study is to compare the clinical results between two different methods of hindfoot endoscopy to treat posterior ankle impingement syndrome.
MATERIALS AND METHODS
Between January 2008 and January 2014, 52 patients who underwent hindfoot endoscopy were retrospectively reviewed. Two methods of hindfoot endoscopy were used; Group A was treated according to van Dijk and colleagues' standard two-portal method, and group B was treated via the modified version of the above, using a protection cannula. For clinical comparison, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, time required to return to activity, and the presence of complications were used.
RESULTS
There was no statistically significant difference in the AOFAS scores at the final follow-up, and there was also no statistically significant difference in the times for the scores to return to the preoperative level. There were no permanent neurovascular injuries and wound problems in either group.
CONCLUSION
Use of protection cannula may provide additional safety during hindfoot endoscopy. We could not prove whether protection cannula can provide superior safety for possible neurovascular injury. Considering the possible safety and risk of using additional instrument, the use of this method may be optional.

Keyword

Hindfoot; Endoscopy; Os trigonum

MeSH Terms

Ankle*
Catheters
Endoscopy*
Follow-Up Studies
Foot
Humans
Methods*
Retrospective Studies
Talus
Wounds and Injuries

Figure

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  Figure 1. Simple lateral radiograph of ankle revealed osteophyte of posterior aspect of the talus on lateral view (arrow).

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  Figure 2. Magnetic resonance images showing prominent osteophyte at posterior aspect of the talus at saggital view (A; arrow) and at axial view (B; arrow).

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  Figure 3. Note the posteromedial cannula inserted for safety (A; arrow), and the cannula can be used for retracting and protecting the surrounding soft tissue, including the neurovascular bundle (B). v.: vein, FHL: flexor hallucis longus tendon, Med.: medial, Lat.: lateral, n.: nerve, Post.: posterior, a.: artery.

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  Figure 4. The osteophyte and the loose body were visualized (A) and removed (B) through the posteromedial portal with a protection cannula.

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  Figure 5. Postoperative radiograph. Osteophyte was removed on lateral view (arrow).

Reference

1.Stone JW., Guhl JF. Diagnostic arthroscopy of the ankle. Andrews JR, Tinnerman LA, editors. editors.Diagnostic and operative arthroscopy. Philadelphia: WB Saunders;1997. p. 423–30.

2.Jerosch J., Fadel M. Endoscopic resection of a symptomatic os trigonum. Knee Surg Sports Traumatol Arthrosc. 2006. 14:1188–93.

3.Golanó P., Vega J., Pérez-Carro L., Götzens V. Ankle anatomy for the arthroscopist. Part I: the portals. Foot Ankle Clin. 2006. 11:253–73.

4.Ferkel RD., Scranton PE Jr. Arthroscopy of the ankle and foot. J Bone Joint Surg Am. 1993. 75:1233–42.

5.Ferkel RD., Heath DD., Guhl JF. Neurological complications of ankle arthroscopy. Arthroscopy. 1996. 12:200–8.

6.van Dijk CN., Scholten PE., Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000. 16:871–6.

7.Abramowitz Y., Wollstein R., Barzilay Y., London E., Matan Y., Sha-bat S, et al. Outcome of resection of a symptomatic os trigonum. J Bone Joint Surg Am. 2003. 85:1051–7.

8.Guo QW., Hu YL., Jiao C., Ao YF., Tian DX. Open versus endoscopic excision of a symptomatic os trigonum: a comparative study of 41 cases. Arthroscopy. 2010. 26:384–90.

9.van Dijk CN. Hindfoot endoscopy. Foot Ankle Clin. 2006. 11:391–414.

10.van Dijk CN. Hindfoot endoscopy for posterior ankle pain. Instr Course Lect. 2006. 55:545–54.

11.Acevedo JI., Busch MT., Ganey TM., Hutton WC., Ogden JA. Coaxial portals for posterior ankle arthroscopy: an anatomic study with clinical correlation on 29 patients. Arthroscopy. 2000. 16:836–42.