Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement

Abstract

Purpose: To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS).

Methods: A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.

Results: Ten patients (4 male and 6 female) with a mean age of 41.9 ± 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 ± 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 ± 10.3 to 80.3 ± 12.6), pain (69.3 ± 11.0 to 78.2 ± 13.9), activities of daily living (61.7 ± 8.8 to 77.93 ± 11.4), sports activities (55.6 ± 12.7 to 76.0 ± 13.6), and quality of life (46.6 ± 9.2 to 71.1 ± 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 ± 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 ± 1.5 (range, 5-10).

Conclusions: The current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again.

Level of evidence: IV, therapeutic case series.

Fig 1

The equipment for the procedure is organized on a Mayo stand, which is draped in a sterile fashion and on which the equipment for the procedure is organized.

Fig 2

In-office needle arthroscopy standard setup.

Fig 3

Relevant preoperative surface anatomy markings and portal locations are indicated on a posterolateral view of the left ankle.

Fig 4

Four-quadrant technique for extra-articular hindfoot structures as defined by the intermalleolar ligament demonstrated on a right ankle. (1) Fibula. (2) Tibia. (3) Posterior inferior tibiofibular ligament. (4) Flexor hallucis longus tendon. (5a) Intermalleolar ligament. (5b) Superior tibial insertion of the intermalleolar ligament. (6) Tibiotalar joint. (7) Subtalar joint. (8) Posterolateral talar process. (9) Flexor hallucis longus retinaculum. (10) Calcaneofibular ligament. (11) Posterior talofibular ligament. Illustration copyright of and reproduced with permission from J. G. Kennedy, M.D. (From Smyth et al.⁹)

Fig 5

Trifurcation of tibial plafond, talar dome, and lateral malleolus of the tibiotalar joint of a left ankle, a typical location for osteochondral lesions.

Fig 6

Extra-articular view of subtalar joint of left ankle.