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Posterior ankle arthroscopy for treating os trigonum syndrome; and acute or chronic os trigonum fractures.
ESSKA Academy. NIKOLOPOULOS D. Nov 8, 2019; 284344; epAFAS-01 Topic: Ankle
Dr. DIMITRIOS NIKOLOPOULOS
Dr. DIMITRIOS NIKOLOPOULOS
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Abstract
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Introduction: The os trigonum (OT) is the most common accessory bone of the foot (posterolateral to the talus). Although it is usually asymptomatic, it may be associated with persistent posterior ankle pain known as 'os trigonum syndrome'.
Objectives: Our objective is to evaluate efficiency and effectiveness of posterior ankle arthroscopy in the treatment of acute or chronic OT fractures and OT syndrome in young athletes.
Aims: To present that posterior arthroscopy is a safe and reliable procedure. It offers earlier recovery with less pain and limited complications.
Methods: From 2011 to 2017, 41 patients (35 males, 07 females) of mean age 23.5 years old (range; 18 to 44) were operated arthroscopically for os trigonum fractures [acute (11/41); chronic (18/41)] or os trigonum syndrome (12/41).Clinical symptoms included deep ankle pain during forced plantarflexion of the ankle (the so-called 'nutcracker sign') persistent swelling, locking and catching or stiffness and limited range of motion on weight bearing. After ankle X-rays, CT scan and MRI was performed in all cases. In prone position, arthroscopically, the os trigonum was removed and the flexor hallucis longus was released. The post-operative regime included a 3-week period of partial weight-bearing, following by full weight bearing. Preoperative and postoperative clinical evaluation was performed at 1 and 2 years based on the VAS, the ankle ROM, the AOFAS scores and the FADI. The patients were followed-up for an average of 3 years (range; 1-5 years).
Results: The VAS score were statistically significant improved from an M=7.7 (5-9) pre- to M=1.1 (0-2) in 6 months post- and to M=0.4 (0-2) in 1 year post-operatively (p< 0,001). The AOFAS and FADI scores were statistically significant improved from an M=40.3 (18-55) and M=53.3 (44-63) pre- to M=95 (85-100) and M=93.2 (89-99) post-operative in 1 year, and to M=95 (85-100) and M=93.2 (89-99) post-operative in 2 years, respectively (p< 0,001). There was improvement on patients' AOFAS and FADI scores from 1 to 2 years; but without to be a statistical significant difference. At last follow-up there were 37 patients (90,2%) with excellent and very good results and 4 (9,8%) with good based on AOFAS score. 37 patients were active at the same level as prior to os trigonum defect, whereas 4 dropped to a lower activity level. There were no complications.
Conclusion: Hindfoot arthroscopy is the gold standard for treating OT fractures and syndrome in young athletes.
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