Clinical Study Of Arthroscopic Treatment For Anterolateral Ankle Impingement Syndrome

Objective Summarize the clinical features of anterolateral ankle impingement syndrome, to investigate the pathology and arthroscopic treatment outcome of anterolateral ankle impingement syndrome and guide clinical treatment.Methods Retrospective analysis clinical data of 22 patients who were diagnised as anterolateral ankle impingement syndrome during the period betweent February 2007 and March 2013, and treated by ankle arthroscopic debridement. 13 of them were males and 9 of them were females, their ages ranged from 16 to 55 years,and their mean age were 34.6 years. 10 cases were in right ankles and 12 cases were in left ankles, all patients had a history of ankle sprain, and twisting of the ankle joint either once or multiple, varus injury in 19 cases, outer injury in 2 cases, sprained mechanism of uncertainty in 1 case. Patients duration of 6 to 12months(mean 8.6months). All patients were diagnosed as anterolateral ankle impingement syndrome according to their history of ankle sprain, clinical symptoms, signs and image performance. All cases were treated arthroscopically, and arthroscopic intervention included clearing the impingement soft tissue and removing osteochondral fragments. Ankle operation used epidural anesthesia. we marked the location of the anteromedial and the anterolateral approach, and the position of the main artery,nerve and tendons before arthroscopic operation. Using anteromedial and the anterolateral approach into the ankle joint and searching in sequence, adding an auxiliary approach when necessary. Under arthroscopy, through passive acted ankle of back stretch, plantar lexion, varus and valgus, and the rotation of the joint, artificial simulated ankle impact performance,observed the impact of location, degree, scope, and impacted the organization’s character. And arthroscopic intervention included clearing the impingement tissue such as hyperplasia synovial, loose bodies, proliferation of osteophytes, and removing osteochondral fragments, gave microfracture to cure articular cartilage injury. The effect of surgery was assessed by hind foot-ankle scoring of American Orthopedic Foot and Ankle Society(AOFAS) and Meislin’s criteria. We used the SPSS16.0 software to analyse the data of 22 patients, uesd mean ± standard deviation to discrible quantitative date, comparision between groups using matching t test. Comparison between unordered categories date using chi-square test, and Ordered categories date using rank sum test, a value of P < 0.05 was considered statistically significant.Results All patients were followed up for 12-24 months. In 22 patients, 12 with synovial tissue impingement, three with meniscoid tissue impingement, three with injury scar tissue impingement of distal fascicle of anterior tibiofibular ligament, four with fibrous scar tissue impingement of anterior talofiular ligament, and 15 with articular cartilage damage. All patients were followed up for 12 to 24 months. The AOFAS scores significantly increased from preoperatively(46.27±12.50) pointsto postoperatively(85.14 ± 10.20) points(P<0.05). Calculate scores pre-and postoperation in accordance with the Meislin’s scoring system: there were 8 cases in excellent, 10 cases in good grade, 4 cases in medium grade, and none was in poor. The excellent and good rate was 81.82%. 15 cases with articular cartilage damage were found in our study, the relationship between impingement and cartilage damage is not significant(X2=1.856,P=1.73),The curative effect is associated with cartilage damage degree, with no or mild damage in the curative effect of cartilage damage relative to the good, the difference is statistically significant(Z=3.250,P=0.01), and further study should be done when more cases are included. Among the 22 patients,there were no complications such as postoperative infection, injury of blood, and neurologic damage.Conclusion The soft tissue impingement syndrome of the anterolateral ankle often occurs following ankle sprain. The impingement soft tissues are the hyperplasia of scar tissue, and articular cartilage damage occur concomitantly in the most cases.Arthroscopy to diagnose and treat anterolateral ankle impingement syndrome is an effective, simple, safe and minimally invasive method.