Abstract
After a posttraumatic ankle pathology, for initial-mild stage of osteoarthritis as rigid ankle, several surgical options can be performed. These include arthroscopic debridement, resurfacing, and osteotomies.
Arthroscopy has been practiced in recent years, especially in young patients after post-traumatic disorders. The goal of arthroscopic debridement is the removal of the fibrous adhesions, synovectomy, removal of osteophytes, and loose bodies if present, assessment and treatment of osteochondral lesion and eventually capsulectomy.
Contraindications are bony or fibrous ankyloses, bone deformities, major axial deviations, neurovascular deficit, and active infections.
Several studies suggested that treatment and prognosis are dependent on the stage of ankle osteoarthritis. Posttraumatic ankle arthritis can be a very disabling condition, and therefore, adequate treatment is helpful.
While some disputes exists regarding arthroscopic debridement of early ankle osteoarthritis and impingement, there is evidence to support benefit of the treatment. By allowing direct, minimally invasive visualization and manipulation of intra-articular structures, ankle arthroscopy offers an important surgical option for the properly selected patient.
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References
Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–6.
Martin RL, Stewart GW, Conti SF. Posttraumatic ankle arthritis: an update on conservative and surgical management. J Orthop Sports Phys Ther. 2007;37(5):253–9.
Day GA, Swanson CE, Hulcombe BG. Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int. 2001;22(2):102–6.
Stufkens SA, van den Bekerom MP, Kerkhoffs GM, Hintermann B, van Dijk CN. Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature. Injury. 2011;42:119–27.
Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five-year functional outcome analysis of ankle fracture fixation. Injury. 2007;38(11):1308–12. https://doi.org/10.1016/j.injury.2007.06.002.
van Dijk CN, Kennedy JG, editors. Talar osteochondral defects. Rio de Janeiro: ESSKA; 2014. https://doi.org/10.1007/978-3-642-45097-6_2.
Thomas B, Yeo JM, Slater GL. Chronic pain after ankle fracture: an arthroscopic assessment case series. Foot Ankle Int. 2005;26(12):1012–6.
Utsugi K, Sakai H, Hiraoka H, Yashiki M, Mogi H. Intra-articular fi brous tissue formation following ankle fracture: the signifi cance of arthroscopic debridement of fi brous tissue. Arthroscopy. 2007;23(1):89–93.
Olson D, Guilak F, editors. Post-traumatic arthritis: pathogenesis, diagnosis and management. New York, NY: Springer Science+Business Media; 2015. p. 285. https://doi.org/10.1007/978-1-4899-7606-2_22.
Urgüden M, Söyüncü Y, Ozdemir H, et al. Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome. Arthroscopy. 2005;21:317–22.
Hassan AH. Treatment of anterolateral impingements of the ankle joint by arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2007;15:1150–4.
van Dijk CN. Ankle arthroscopy. Berlin: Springer-Verlag; 2014. https://doi.org/10.1007/978-3-642-35989-7_1.
Claessen FMAP, Meijer DT, van den Bekerom MPJ, Gevers Deynoot BDJ, Mallee WH, Doornberg JN, van Dijk CN. Reliability of classification for post-traumatic ankle osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1332–7. https://doi.org/10.1007/s00167-015-3871-6.
Van Dijk CN, Tol JL, Verheyen CC. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med. 1997;25:737–45.
Tol JL, van Dijk CN. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle Int. 2004;25(6):382–6.
Van Dijk CN, Verhagen RA, Tol JL. Arthroscopy for problems after ankle fracture. J Bone Joint Surg. 1997;79-B(2):280–4. https://doi.org/10.1302/0301-620X.79B2.7153.
Tol JL, Verhagen RA, Krips R, Maas M, Wessel R, Dijkgraaf MGW, Van Dijk CN. The anterior ankle impingement syndrome: diagnostic value of oblique radiographs. Foot Ankle Int. 2004;25(2):63–8.
Reilingh ML, Beimers L, Tuijthof GJM, Stufkens SAS, Maas M, van Dijk CN. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skelet Radiol. 2010;39(11):1103–8. https://doi.org/10.1007/s00256-009-0857-9.
Lui TH, Chan WK, Chan KB. The arthroscopic management of frozen ankle. Arthroscopy. 2006;22(3):283–6. https://doi.org/10.1016/j.arthro.2005.12.012
Branca A, DiPalma L, Bucca C, et al. Arthroscopic treatment of anterior ankle impingement. Foot Ankle Int. 1997;28:418–23.
Osti L, Del Buono A, Maffulli N. Arthroscopic debridement of the ankle for mild to moderate osteoarthritis: a midterm follow-up study in former professional soccer players. J Orthop Surg Res. 2016;11:37. https://doi.org/10.1186/s13018-016-0368-z.
Phisitkul P, Tennant JN, Amendola A. Is there any value to arthroscopic debridement of ankle osteoarthritis and impingement? Foot Ankle Clin. 2013;18(3):449–58. https://doi.org/10.1016/j.fcl.2013.06.004.
van Eekeren IC, Reilingh ML, van Dijk CN. Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects. Sports Med. 2012;42:857–70.
Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR, et al. Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res. 2003;407:215–27.
Gill TJ, McCulloch PC, Glasson SS, Blanchet T, Morris EA. Chondral defect repair after the microfracture procedure: a nonhuman primate model. Am J Sports Med. 2005;33:680–5.
Carpenter B, Motley T. The role of viscosupplementation in the ankle using Hylan GF-20. J Foot Ankle Surg. 2008;47(5):377–84.
Migliore A, Giovannangeli F, Bizzi E, Massafra U, Alimonti A, Laganà B, Piscitelli P. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg. 2011;131(1):139–47. https://doi.org/10.1007/s00402-010-1165-5.
Karlsson J. Low risk of complications during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012;20:1419.
Zengerink M, Van Dijk CN. Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1420–31.
Dawe EJC, Jukes CP, Ganesan K, Wee A, Gougoulias N. Ankle arthroscopy to manage sequelae after ankle fractures. Knee Surg Sports Traumatol Arthrosc. 2015;23:3393–7. https://doi.org/10.1007/s00167-014-3140-0.
Kim HN, Park YJ, Kim GL, Park YW. Arthroscopy combined with hardware removal for chronic pain after ankle fracture. Knee Surg Sports Traumatol Arthrosc. 2013;21:1427–33.
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Clinical case of posttraumatic ankle in a 46-year-old man. Weight-bearing Rx and MRI was performed in preoperative. This video shows ankle debridement with partial removal of anterior tibial osteophyte and microfracture for symptomatic medial OCL (MP4 321,407 kb)
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Ceccarini, P., Pantalone, A., Antinolfi, P., Rinonapoli, G., Caraffa, A., Guelfi, M. (2020). Ankle Joint Debridement. In: Allegra, F., Cortese, F., Lijoi, F. (eds) Ankle Joint Arthroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29231-7_22
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