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Posterior arthroscopic ankle release in patients with symptomatic restriction of ankle dorsiflexion secondary to posterior hinge impingement (PHI) – a consecutive, prospective case series.
ESSKA Academy. Hickey B. Nov 9, 2019; 286369
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Posterior arthroscopic ankle release in patients with symptomatic restriction of ankle dorsiflexion secondary to posterior hinge impingement (PHI) – a consecutive, prospective case series.

AFAS Free Papers

Topic: Arthroscopy

Hickey B.1, Dalmau-Pastor M.2, Karlsson J.3, Calder J.4
1Wrexham Maelor Hospital, Wrexham, United Kingdom, 2University of Barcelona, Barcelona, Spain, 3University of Gothenburg, Goteborg, Sweden, 4Fortius Clinic, London, United Kingdom

Introduction: Restricted ankle dorsiflexion can be the result of anterior bone or soft tissue ankle pathology causing impingement pain or secondary to degenerative changes of the ankle joint. Severe soft-tissue trauma following injuries such as ankle fracture-dislocation may result in capsular fibrosis with limited ankle dorsiflexion despite anatomical reduction and appropriate fixation. Contracture of the posterior structures may restrict ankle movement by creating a 'hinge-effect' rotating through the posterior capsule rather than the centre of rotation in the talus and this may therefore result in anterior impingement and associated anterior ankle pain during weight-bearing ankle dorsiflexion
Aims: Our aim was to evaluate the effect of arthroscopic release of the posterior capsuloligamentous structures on ankle dorsiflexion and function in patients with painful limitation of ankle dorsiflexion.
Methods: A prospective consecutive case series of 13 adult patients with painful limitation of ankle dorsiflexion were included. None had clinically relevant gastrocnemius, soleus or Achilles contracture. Patients with anterior bony impingement or ankle degeneration on CT scan were excluded. All patients underwent combined anterior and posterior ankle arthroscopy with resection of posterior capsuloligamentous structures and the posterior fibulotalocalcaneal ligament. Ankle range of motion was assessed 2 years post-operatively. FAOS scores were used to assess functional outcome.
Results: The median patient age at surgery was 26 years (range 19-44). At 2 years post-surgery, ankle dorsiflexion range had increased by 15 degrees (range 0 to 25, p< 0.0001). FAOS scores completed at a median of 44 months post-surgery (range 26-72) significantly improved. Median improvements were 19 points for pain (6 to 67, p=0.0004), 14 points for symptoms (3 to 36, p=0.0005), 15 points for activities of daily living (6 to 35, p< 0.0001), 45 points for sport (20 to 55, p< 0.0001) and 50 points for quality of life (13 to 62, p< 0.0001).
Conclusions: Arthroscopic release of the posterior ankle structures including the posterior fibulotalocalcaneal ligament is a safe and effective technique for improving ankle dorsiflexion range in patients with painful limitation of ankle dorsiflexion. It reduces ankle pain even in the absence of anterior bone or soft tissue impingement.
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