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Abstract：
OBJECTIVE: The purpose of this study was to identify and characterize various causes of delay in the diagnosis of posterior ankle impingement syndrome (PAIS) in pediatric patients.
METHODS: IRB approved prospective study of patients under 18 years who underwent arthroscopic surgery for the diagnosis of posterior ankle impingement after failed conservative treatment at a tertiary children\'s hospital. Radiographic findings were compared with an age-matched control group. Descriptive and inferential statistics were employed.
RESULTS: 47 patients (61 ankles), mean age 13 years, had an average 14 months delay in diagnosis of PAIS from the initial presentation. 33 (70%) patients had seen multiple medical providers and given other diagnoses. 9 (19%) patients participated in ballet or soccer, and 16 (34%) patients had unrelated associated foot and ankle diagnoses. 25 (41%) of 61 ankles did not have pain on forced plantar flexion; all 61(100%) ankles had tenderness to palpation over the posterior ankle joint line. Radiographs were reported to be normal in 37/52 (71%) ankles, while MRI report did not mention the diagnosis in 20/41 (49%) studies. There was a significant difference in the MRI findings in the patient population when compared to the control group. Indication for surgery was failed conservative treatment. All 61 ankles had posterior ankle impingement pathology confirmed visually during arthroscopy. At average 15 months follow-up, there was significant improvement pre- to post-operatively (p<0.001) for both pain VAS (6.9-0.9) and AOFAS ankle-hindfoot scores (65-94).
CONCLUSIONS: Multiple clinical and imaging factors can lead to delayed diagnosis of posterior ankle impingement. An increased awareness about the features of PAIS is needed amongst medical providers involved in treating young patients.
METHODS: IRB approved prospective study of patients under 18 years who underwent arthroscopic surgery for the diagnosis of posterior ankle impingement after failed conservative treatment at a tertiary children\'s hospital. Radiographic findings were compared with an age-matched control group. Descriptive and inferential statistics were employed.
RESULTS: 47 patients (61 ankles), mean age 13 years, had an average 14 months delay in diagnosis of PAIS from the initial presentation. 33 (70%) patients had seen multiple medical providers and given other diagnoses. 9 (19%) patients participated in ballet or soccer, and 16 (34%) patients had unrelated associated foot and ankle diagnoses. 25 (41%) of 61 ankles did not have pain on forced plantar flexion; all 61(100%) ankles had tenderness to palpation over the posterior ankle joint line. Radiographs were reported to be normal in 37/52 (71%) ankles, while MRI report did not mention the diagnosis in 20/41 (49%) studies. There was a significant difference in the MRI findings in the patient population when compared to the control group. Indication for surgery was failed conservative treatment. All 61 ankles had posterior ankle impingement pathology confirmed visually during arthroscopy. At average 15 months follow-up, there was significant improvement pre- to post-operatively (p<0.001) for both pain VAS (6.9-0.9) and AOFAS ankle-hindfoot scores (65-94).
CONCLUSIONS: Multiple clinical and imaging factors can lead to delayed diagnosis of posterior ankle impingement. An increased awareness about the features of PAIS is needed amongst medical providers involved in treating young patients.
摘要：
目的：这项研究的目的是确定和表征儿科患者后踝关节撞击综合征（PAIS）诊断延迟的各种原因。
方法：IRB批准了在三级儿童医院保守治疗失败后接受关节镜手术诊断后踝关节撞击的18岁以下患者的前瞻性研究。将影像学检查结果与年龄匹配的对照组进行比较。采用了描述性和推断性统计数据。
结果：47例患者（61个脚踝），平均年龄13岁,从初次报告开始，PAIS的诊断平均延迟14个月。33名（70％）患者曾看过多个医疗服务提供者并进行了其他诊断。9名（19％）患者参加了芭蕾舞或足球比赛，16例(34%)患者的足部和踝关节诊断无关.61个脚踝中的25个（41％）在强迫足屈时没有疼痛；所有61个（100％）脚踝在后踝关节线上触诊时都有压痛。据报道，37/52（71％）脚踝的X光片正常，而20/41(49%)研究中MRI报告未提及诊断。与对照组相比，患者人群的MRI发现存在显着差异。手术指征为保守治疗失败。在关节镜检查期间，所有61个脚踝均有后踝关节撞击病理证实。平均随访15个月,疼痛VAS(6.9-0.9)和AOFAS踝足-后足评分(65-94)在手术前后均有显著改善(p<0.001).
结论：多种临床和影像学因素可导致后踝关节撞击的诊断延迟。在参与治疗年轻患者的医疗提供者中，需要提高对PAIS特征的认识。
方法：IRB批准了在三级儿童医院保守治疗失败后接受关节镜手术诊断后踝关节撞击的18岁以下患者的前瞻性研究。将影像学检查结果与年龄匹配的对照组进行比较。采用了描述性和推断性统计数据。
结果：47例患者（61个脚踝），平均年龄13岁,从初次报告开始，PAIS的诊断平均延迟14个月。33名（70％）患者曾看过多个医疗服务提供者并进行了其他诊断。9名（19％）患者参加了芭蕾舞或足球比赛，16例(34%)患者的足部和踝关节诊断无关.61个脚踝中的25个（41％）在强迫足屈时没有疼痛；所有61个（100％）脚踝在后踝关节线上触诊时都有压痛。据报道，37/52（71％）脚踝的X光片正常，而20/41(49%)研究中MRI报告未提及诊断。与对照组相比，患者人群的MRI发现存在显着差异。手术指征为保守治疗失败。在关节镜检查期间，所有61个脚踝均有后踝关节撞击病理证实。平均随访15个月,疼痛VAS(6.9-0.9)和AOFAS踝足-后足评分(65-94)在手术前后均有显著改善(p<0.001).
结论：多种临床和影像学因素可导致后踝关节撞击的诊断延迟。在参与治疗年轻患者的医疗提供者中，需要提高对PAIS特征的认识。
