Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes

Abstract

ObjectiveTo describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players.Material and methodsA case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures.ResultsThe complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24–42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42–56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19–77 months).ConclusionNon-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails.Level of evidenceLevel IV, Therapeutic study

Implications of Classification of Os Trigonum: A Study Based on Computed Tomography Three-Dimensional Imaging

“…In this study, the incidence of type III os trigonum was the highest among all types, and in a study of ballet dancers, the incidence rate of type III reached 44% [5,6,19,23], perhaps due to dancing from an early age, the development of os trigonum was affected. There was the pain in type III os trigonum, which was mostly caused by the thickening of the posterior capsule of ankle joint caused by impacted tenosynovitis of pollicis longus muscle and edema of soft tissue around it [18,24].…”

“…Single or repeated forced plantar flexion can lead to degeneration or tearing of articular cartilage. Repeated impacts on the posterior triangular bone of the adjacent soft tissue may cause pain in the posterior side of the ankle and swelling around the triangular bone [4,5]. The fracture of the posterior process of talus and the fracture of the posterior triangle of the talus are easy to be confused clinically, and computed tomography (CT) scans and magnetic resonance imaging can detect the associated bone and soft tissue abnormalities, thus complementing each other [6,7].…”

Posterior ankle impingement syndrome in athletes

“…No entanto, não se pode concluir com precisão a efetividade do tratamento conservador, não havendo até o momento um estudo com seguimento a longo prazo que enumere com validade científica esse tratamento (2) . Casos em que sejam identificadas alterações anatômicas associadas à persistência da queixa (falha do tratamento conservador) e redução do desempenho esportivo, apresentam a indicação precisa de abordagem cirúrgica (2)(3)(4)6,15) .…”

“…O advento da técnica artroscópica popularizada por van Dijk (21) com 2 portais posteriores permite uma abordagem minimante invasiva do impacto posterior e anormali-dades locais associadas. Essa técnica é considerada válida e segura para o tratamento de lesões na região posterior do tornozelo, como também apresenta melhores resultados como o menor tempo para retorno a atividade esportiva em comparação à cirurgia aberta (2)(3)(4)15) . As taxas de complicações são menores conforme encontrado na revisão sistemática conduzida por Zwiers et al (22) a qual incluiu 16 estudos e 419 tornozelos, a taxa de complicações foi de (7.2 vs 15.9%) e o retorno médio à atividade foi de 11.3 semanas em comparação a 16 semanas na técnica aberta (22) .…”

“…A PAIS é uma condição que se resume em um grupo de alterações patológicas resultantes da exposição do pé ao movimento de flexão constante ou trauma repetido local (3) . Diversas alterações anatômicas podem causar impacto posterior do tornozelo, destacando-se como principais a ocorrência de proeminências ósseas, músculos anômalos e hipertrofias ligamentares (2)(3)(4)(5) .…”