Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment

Abstract

Background: Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention.

Methods: Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit.

Results: Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (P<or=0.001). Mean time to return to full activity after surgery was 2.5 months (0.7-4.7 mo) excluding 4 patients who had delayed return or no return. Complications in these 4 patients included 2 cutaneous neuromas, 1 complex regional pain syndrome, and 1 adolescent with nonassociated chondromalacia.

Conclusions: Knowledge of this entity is critical for making the correct diagnosis and eventual treatment. In fact, once the diagnosis of impingement is confirmed by clinical and radiographic evaluation there seems to be no significant improvement with nonsurgical treatment. Arthroscopic debridement is an accepted method of treatment and our results in adolescents echo those found in the adult literature. Functional improvement can be obtained via surgical debridement for all types of anterolateral ankle impingement in the adolescent population.