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. 2020 Sep 23;5(3):2473011420945330.
doi: 10.1177/2473011420945330. eCollection 2020 Jul.

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

Dimitrios Nikolopoulos  1   2 , George Safos  1   2 , Konstantinos Moustakas  1   2 , Neoptolemos Sergides  1   2 , Petros Safos  2   3 , Athanasios Siderakis  3 , Dimitrios Kalpaxis  2   4 , Andreas Moutsios-Rentzos  5
Affiliations

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

Dimitrios Nikolopoulos et al. Foot Ankle Orthop. .

Abstract

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.

Keywords: hindfoot arthroscopy; os trigonum; posterior ankle syndrome; posterior arthroscopy; posterior impingement.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
(A) Preoperative ankle radiograph (lateral view) showing the os trigonum (OT) in the posterior talus area, as indicated by an arrow. (B) Preoperative ankle computed tomographic scan showing the fractured OT after ankle injury. (C) Preoperative ankle magnetic resonance imaging (MRI) showing the OT pathology of the patient.
Figure 2.
Figure 2.
(A) The posterolateral portal is the first portal to be made, in front of the Achilles tendon is a line from the tip of the lateral malleolus to the Achilles tendon, parallel to the sole of the foot. (B) The posteromedial portal is the second portal be made at the same level as posterolateral. (C) The position of the 30-degree arthroscope and the shaver during the posterior arthroscopic operation.
Figure 3.
Figure 3.
Operative arthroscopic images of different cases: (A) Os trigonum (OT). (B) Removing with arthroscopic grasp the OT. (C) Release of flexor hallucis longus tendon with flexor retinaculum. (D) Large OT removal with arthroscopic grasp. (E) Large OT. (F) Detaching OT from the posterior talus area.
See this image and copyright information in PMC

References

    1. Abramowitz Y, Wollstein R, Barzilay Y, et al. Outcome of resection of a symptomatic os trigonum. J Bone Joint Surg Am. 2003;85:1051–1057. - PubMed
    1. Ahn JH, Kim YC, Kim HY. Arthroscopic versus posterior endoscopic excision of a symptomatic os trigonum: a retrospective cohort study. Am J Sports Med. 2013;41(5):1082–1089. - PubMed
    1. Anwar R, Nicholl JE. Non-union of a fractured os trigonum. Injury. 2005;36:267–270.
    1. Best A, Giza E, Linklater J, Sullivan M. Posterior impingement of the ankle caused by anomalous muscles: a report of four cases. J Bone Joint Surg Am. 2005; 87(9):2075–2079. - PubMed
    1. Brodsky AE, Khalil MA. Talar compression syndrome. Am J Sports Med. 1986;14(6):472–476. - PubMed