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. 2024 Jul;52(8):2168-2177.
doi: 10.1177/03635465231198425. Epub 2024 Feb 13.

The Utilization of Minimally Invasive Surgery for Os Trigonum Syndrome: A Systematic Review

Albert T Anastasio  1 , Anthony N Baumann  2 , Kempland C Walley  3 , Deven P Curtis  2 , William L Johns  4 , Annunziato Amendola  1
Affiliations

The Utilization of Minimally Invasive Surgery for Os Trigonum Syndrome: A Systematic Review

Albert T Anastasio et al. Am J Sports Med. 2024 Jul.

Abstract

Background: A symptomatic os trigonum is a common cause of posterior ankle pain that has been traditionally managed with open excision. Minimally invasive surgery (MIS) has been proposed as an alternative to open excision for improved outcomes and decreased complication rates; however, no systematic review to date has examined the utilization of MIS for a symptomatic os trigonum.

Purpose: To examine patient outcomes, return to sport, and complications associated with MIS for a symptomatic os trigonum.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review was performed on February 22, 2023, using the PubMed, CINAHL, MEDLINE, and Web of Science databases from database inception until February 22, 2023, on the topic of MIS for a symptomatic os trigonum.

Results: Of 885 articles retrieved from an initial search, 17 articles (N = 435 patients) met full inclusion criteria. The mean age of the cohort was 26.01 ± 4.68 years, with a mean follow-up time of 34.63 ± 18.20 months. For patients treated with MIS, the mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 55.85 ± 12.75, the mean final postoperative AOFAS score was 94.88 ± 4.04, the mean preoperative visual analog scale pain score was 7.20 ± 0.43, and the mean final postoperative visual analog scale score was 0.71 ± 0.48. The mean time to return to sport for patients undergoing MIS was 7.76 ± 1.42 weeks. MIS had an overall complication rate of 5.0%, the majority of which consisted of transient neurapraxia of the sural or superficial peroneal nerve.

Conclusion: Minimally invasive management of a symptomatic os trigonum appears to be a viable alternative to open surgery in terms of outcomes, return to sport, and complication rates. More high-quality evidence will be required to definitely recommend minimally invasive approaches as the standard of care over open surgery.

Keywords: arthroscopic; endoscopic; minimally invasive surgery; os trigonum; posterior ankle impingement.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: ATA receives consulting fees with QPIX solutions. AA receives consulting fees and/or royalties from Arthrosurface, Smith & Nephew, Extremity Development, First Ray, Rubber City Bracing, Springer, and Wolters Kluwer-Lippincott Williams & Wilkins. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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