Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement

Abstract

Purpose: To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS). Methods: A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. Results: Ten patients (4 male and 6 female) with a mean age of 41.9 AE 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 AE 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 AE 10.3 to 80.3 AE 12.6), pain (69.3 AE 11.0 to 78.2 AE 13.9), activities of daily living (61.7 AE 8.8 to 77.93 AE 11.4), sports activities (55.6 AE 12.7 to 76.0 AE 13.6), and quality of life (46.6 AE 9.2 to 71.1 AE 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 AE 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 AE 1.5 (range, 5-10). Conclusions: The current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again. Level of Evidence: IV, therapeutic case series.P osterior ankle impingement syndrome (PAIS) is a syndrome involving posterior hindfoot pain due to the impingement of the posterior ankle joint. PAIS can be debilitating, especially in athletes enduring repeated plantarflexion, like ballet dancers, soccer players, and downhill runners. 1 Several factors may contribute to the development of PAIS, including but not limited to variations in soft tissue and bony anatomy, such as an os trigonum or Stieda process. 2 With repetitive plantarflexion, soft or bony tissue may become compressed,

Wide-Awake Needle Arthroscopy of the Anterior Ankle: A Standardized Approach

“… 14 Patient tolerability of needle arthroscopy of the ankle under local anesthesia has been tested as well and was found to be excellent in procedures ranging from inspection-injections to debridement of bony impingement and lavage for bacterial arthritis. 15 , 16 , 17 , 18 …”

In-Office Needle Arthroscopy: Indications, Surgical Techniques, Tips, and Tricks

“…Using a sterile technique, the extremity is prepped using a solution of chlorhexidine gluconate mixed with isopropyl alcohol and draped. 1 , 2 After 5 to 10 minutes, 20 cc of 1% lidocaine and 0.5% bupivacaine in a 1:1 ratio is injected through the portal sites into the joint. An 11 blade is used to make portal stab incisions.…”

“…Typically, IONA procedures afford patients early mobilization and range of motion with quicker return to work and day-to-day activities. 1 , 2 , 5 The pearls and pitfalls are summarized in Table 2 .…”

“…The effect on the patients' outcomes, by being able to see their pathology in real time and by being able to see what was being done to address this, allowing them to be directly involved in their own care, has benefits downstream in expectation of outcome and compliance with postoperative regimens that have been seen in several studies. 1 , 2 This article will present the indications for IONA in upper and lower extremity injuries and will describe the best practice office setup. Technical pearls and pitfalls will also be discussed.…”

Needle Arthroscopy Demonstrates High Sensitivity and Specificity for Diagnosing Intra-Articular Shoulder and Knee Pathology

“…Additionally, these scopes omit the need for general anesthesia or fluid pump irrigation systems while still allowing for direct visualization and immediate diagnostic information [ 3 , 6 , 7 ]. Furthermore, newer second-generation needle arthroscopy devices report 3-5x higher image resolutions than older devices [ 8 ].…”