Ankle arthroscopy in children

Abstract

INTRODUCTION Arthroscopy of the ankle has gained acceptance as a procedure for diagnosing and treating chronic and post-traumatic ankle problems. The senior author's perception is that magnetic resonance imaging (MRI) under-diagnoses anterior soft tissue impingement lesions in children. The purpose of this study was retrospectively to analyse the outcome of ankle arthroscopy in the paediatric age group. PATIENTS AND METHODS Between March 2005 and September 2007, 23 children underwent ankle arthroscopy for post-traumatic pathology. The indications for arthroscopy were failure of non-operative treatment for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging. RESULTS At arthroscopy, OCDs were visualised in 12 cases and impingement lesions were seen in 17 ankles. MRI was performed in 8 of these 12 cases and only 1 suggested the possibility of an impingement lesion. Of the 17 cases of impingement seen on arthroscopy, 12 reported mechanical symptoms preoperatively and 4 were unstable on examination under anaesthetic. Eighteen of the twenty-three patients had complete relief of symptoms at 3 months. Eighteen children who were evaluated at one-year follow up had a mean American Orthopaedic Foot and Ankle Society score of 87. 5 (range: 49-100). CONCLUSIONS Ankle arthroscopy has a successful outcome in paediatric patients and the results are comparable with those reported in adult series. MRI was found to be insensitive for the diagnosis of soft tissue impingement of the ankle.

Posterior ankle impingement–an underdiagnosed cause of ankle pain in pediatric patients

“…MRI is considered a useful diagnostic modality for assessment of the pathology in ankle impingement[6,14]. However, MRI has been shown to be an insensitive modality for ankle imaging in the pediatric population[15]. The most common MRI findings in our study included the presence of an os trigonum or Stieda process, with associated osseous and soft tissue edema which is similar to what prior studies in the literature have reported[6,12,14,16].…”

Delayed presentation of a loose body in undisplaced paediatric talar neck fracture

“…The role of ankle arthroscopy in the management of chronic and post-traumatic ankle disorders in adults is well established. Uglow and colleagues [11] reported outcomes in children following arthroscopy being comparable to adult series for the management of OCDs and anterolateral soft tissue impingement. In particular they highlighted the poor correlation between findings on MRI and intraoperative findings on arthroscopy especially in relation to small OCDs and impingements lesions.…”

Artroscopia de tobillo en niños y adolescentes: análisis de las indicaciones y complicaciones

“…[12][13][14] Sin embargo, existe mínima información sobre la eficacia y seguridad de este procedimiento aplicado a patologías del tobillo en niños y adolescentes. [15][16][17][18] El objetivo de este estudio es revisar las indicaciones y complicaciones de la artroscopia de tobillo en una cohorte de pacientes ≤ 18 años. Debido a que el tamaño de la articulación en niños es menor (lo que incrementa la dificultad técnica) y el volumen de cirugías en el mismo periodo también es menor (lo que alarga la curva de aprendizaje), nuestra hipótesis es que el porcentaje de complicaciones sería mayor.…”