Posterior ankle impingement syndrome(PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior twop...Posterior ankle impingement syndrome(PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior twoportal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot(superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.展开更多
BACKGROUND Posterior ankle impingement syndrome(PAIS)is a cause of ankle pain due to pinching of bony or soft tissue structures in the hindfoot.The diagnosis is primarily made based on detailed history and accurate cl...BACKGROUND Posterior ankle impingement syndrome(PAIS)is a cause of ankle pain due to pinching of bony or soft tissue structures in the hindfoot.The diagnosis is primarily made based on detailed history and accurate clinical examination.The delay in its diagnosis has not yet been described in the pediatric and adolescent population.AIM To identify and characterize misdiagnosed cases of PAIS in pediatric and adolescent patients.METHODS This descriptive prospective study at a tertiary children’s hospital included patients≤18 years who underwent posterior ankle arthroscopy after presenting with chronic posterior ankle pain after being diagnosed with PAIS.Collected data included:Demographics,prior diagnoses and treatments,providers seen,time to diagnosis from presentation,and prior imaging obtained.Visual Analogue Scale(VAS)for pain and American Orthopedic Foot Ankle Society(AOFAS)ankle-hindfoot scores were noted at initial presentation and follow-up.RESULTS 35 patients(46 ankles)with average age of 13 years had an average 19 mo(range 0-60 mo)delay in diagnosis from initial presentation.25(71%)patients had previously seen multiple medical providers and were given multiple other diagnoses.All 46(100%)ankles had tenderness to palpation over the posterior ankle joint.Radiographs were reported normal in 31/42(72%)exams.In 32 ankles who underwent MRI,the most common findings included os trigonum(47%)/Stieda process(47%).Conservative treatment had already been attempted in all patients.Ankle impingement pathology was confirmed during arthroscopy in 46(100%)ankles.At an average follow-up of 13.1 mo,there was an improvement of VAS(pre-op 7.0 to post-op 1.2)and AOFAS scores(pre-op 65.1 to post-op 94).CONCLUSION This is the first study which shows that PAIS is a clinically misdiagnosed cause of posterior ankle pain in pediatric and adolescent population;an increased awareness about this diagnosis is needed amongst providers treating young patients.展开更多
目的探讨踝关节镜经后方入路治疗距后三角骨综合征的临床疗效及安全性。方法 2011-09/2015-12月,对作者医院12例距后三角骨综合征患者进行后方入路踝关节镜手术治疗。其中男9例,女3例;年龄24~57岁,平均30.4岁;右侧8例,左侧4例。手术前...目的探讨踝关节镜经后方入路治疗距后三角骨综合征的临床疗效及安全性。方法 2011-09/2015-12月,对作者医院12例距后三角骨综合征患者进行后方入路踝关节镜手术治疗。其中男9例,女3例;年龄24~57岁,平均30.4岁;右侧8例,左侧4例。手术前后根据美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝关节与后足功能评分标准及视觉模拟评分(visual analog scale,VAS)法评价患者的主观疗效满意度。结果12例患者均获有效随访,随访时间为6~26个月,平均15.6个月。术前AOFAS踝关节与后足功能评分为(62.3±7.5)分,术后为(92.4±4.8)分;术前VAS为(5.33±1.25)分,术后为(0.84±0.38)分,术后较术前评分改善均具有统计学意义(P<0.05)。所有患者均未出现血管神经损伤、感染、肌腱粘连及关节僵硬等并发症。术后满意度100%。结论经后方入路踝关节镜治疗距后三角骨综合征临床效果好,并发症少,安全可靠。展开更多
文摘Posterior ankle impingement syndrome(PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior twoportal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot(superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.
文摘BACKGROUND Posterior ankle impingement syndrome(PAIS)is a cause of ankle pain due to pinching of bony or soft tissue structures in the hindfoot.The diagnosis is primarily made based on detailed history and accurate clinical examination.The delay in its diagnosis has not yet been described in the pediatric and adolescent population.AIM To identify and characterize misdiagnosed cases of PAIS in pediatric and adolescent patients.METHODS This descriptive prospective study at a tertiary children’s hospital included patients≤18 years who underwent posterior ankle arthroscopy after presenting with chronic posterior ankle pain after being diagnosed with PAIS.Collected data included:Demographics,prior diagnoses and treatments,providers seen,time to diagnosis from presentation,and prior imaging obtained.Visual Analogue Scale(VAS)for pain and American Orthopedic Foot Ankle Society(AOFAS)ankle-hindfoot scores were noted at initial presentation and follow-up.RESULTS 35 patients(46 ankles)with average age of 13 years had an average 19 mo(range 0-60 mo)delay in diagnosis from initial presentation.25(71%)patients had previously seen multiple medical providers and were given multiple other diagnoses.All 46(100%)ankles had tenderness to palpation over the posterior ankle joint.Radiographs were reported normal in 31/42(72%)exams.In 32 ankles who underwent MRI,the most common findings included os trigonum(47%)/Stieda process(47%).Conservative treatment had already been attempted in all patients.Ankle impingement pathology was confirmed during arthroscopy in 46(100%)ankles.At an average follow-up of 13.1 mo,there was an improvement of VAS(pre-op 7.0 to post-op 1.2)and AOFAS scores(pre-op 65.1 to post-op 94).CONCLUSION This is the first study which shows that PAIS is a clinically misdiagnosed cause of posterior ankle pain in pediatric and adolescent population;an increased awareness about this diagnosis is needed amongst providers treating young patients.
文摘目的探讨踝关节镜经后方入路治疗距后三角骨综合征的临床疗效及安全性。方法 2011-09/2015-12月,对作者医院12例距后三角骨综合征患者进行后方入路踝关节镜手术治疗。其中男9例,女3例;年龄24~57岁,平均30.4岁;右侧8例,左侧4例。手术前后根据美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝关节与后足功能评分标准及视觉模拟评分(visual analog scale,VAS)法评价患者的主观疗效满意度。结果12例患者均获有效随访,随访时间为6~26个月,平均15.6个月。术前AOFAS踝关节与后足功能评分为(62.3±7.5)分,术后为(92.4±4.8)分;术前VAS为(5.33±1.25)分,术后为(0.84±0.38)分,术后较术前评分改善均具有统计学意义(P<0.05)。所有患者均未出现血管神经损伤、感染、肌腱粘连及关节僵硬等并发症。术后满意度100%。结论经后方入路踝关节镜治疗距后三角骨综合征临床效果好,并发症少,安全可靠。
