Abstract：
BACKGROUND: Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS.
METHODS: Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months.
RESULTS: The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (p < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (p < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure.
CONCLUSIONS: Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.
METHODS: Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months.
RESULTS: The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (p < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (p < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure.
CONCLUSIONS: Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.
摘要：
背景：后踝关节撞击综合征（PAIS）可能是由长屈肌腱病引起的，由于三角骨的存在而压缩距骨的后突，软组织撞击,或者这些的组合。患者仰卧通过双后内侧门户进行后关节外内窥镜检查，切除粘连，切除距骨或三角后突，和长屈屈肌腱（FHL）的减压，可用于PAIS运动员。
方法：34名保守治疗失败的PAIS运动员使用双后内侧门户进行仰卧位后踝镜检查。使用美国骨科足踝协会后足量表评分对患者进行术前和术后评估，Tegner量表,和简单的视觉模拟量表。手术时间,回到运动,患者满意度,记录和分析并发症。术后随访24～72个月,平均26.7±12.6个月。
结果：术后Tegner活动量表评分均值提高到9±0.2（p<0.05），而美国骨科足踝协会的平均评分在术后改善到96±5.1（范围87至100），34例患者中有29例（85.3%）达到100分（p<0.05）。恢复运动的平均时间为8.7±0.7（范围8至10）周。并发症发生率低，没有浅表伤口感染或静脉血栓栓塞事件;只有2例患者(5.9%)在索引程序后3个月报告疼痛和压痛。
结论：后踝内窥镜检查用于切除距骨或三角后突和FHL肌腱减压术是安全的，并且在PAIS运动员中具有较低的发病率。
方法：34名保守治疗失败的PAIS运动员使用双后内侧门户进行仰卧位后踝镜检查。使用美国骨科足踝协会后足量表评分对患者进行术前和术后评估，Tegner量表,和简单的视觉模拟量表。手术时间,回到运动,患者满意度,记录和分析并发症。术后随访24～72个月,平均26.7±12.6个月。
结果：术后Tegner活动量表评分均值提高到9±0.2（p<0.05），而美国骨科足踝协会的平均评分在术后改善到96±5.1（范围87至100），34例患者中有29例（85.3%）达到100分（p<0.05）。恢复运动的平均时间为8.7±0.7（范围8至10）周。并发症发生率低，没有浅表伤口感染或静脉血栓栓塞事件;只有2例患者(5.9%)在索引程序后3个月报告疼痛和压痛。
结论：后踝内窥镜检查用于切除距骨或三角后突和FHL肌腱减压术是安全的，并且在PAIS运动员中具有较低的发病率。
