Anterior ankle bony impingement with joint motion loss: the arthroscopic resection option.

OBJECTIVES: This study presents an arthroscopic surgery technique for the treatment of bony anterior ankle impingement with tibiotalar joint stiffness, and initial short-term results. SURGICAL TECHNIQUE: All patients underwent the same arthroscopic technique, with anterior ankle synovectomy, osteophyte resection and extensive anterior capsuloligamentous structures release. Rehabilitation was immediately initiated. SERIES: This was a retrospective series of 13 cases of bony ankle impingement associated with poorly tolerated range of motion restriction. At a mean 15 months' follow-up, 10 out of 13 patients were satisfied or very satisfied with their result, and three were disappointed. Anterior impingement symptoms had entirely disappeared in 12 of the 13 cases. Five patients showed persistent deep pain. Mean dorsiflexion improved from 7 degrees to 16 degrees (p<0.009) and mean plantar flexion from 20 degrees to 34 degrees (p<0.004). Mean AOFAS score improved from 67/100 (54-80) to 87/100 (43-100) (p<0.05). DISCUSSION: In the particular case of bony ankle impingement associated with poorly tolerated range of motion restriction, both pain and joint mobility can be improved by simple arthroscopic surgical techniques combining anterior synovectomy, extensive anterior capsuloligamentous release, large-scale osteophyte resection and malleolar groove release. Surgery should immediately be followed by a program of mobilization and rehabilitation in hospital, with pain management. Short-term results are encouraging, providing clear functional improvement and overall ankle mobility gain. LEVEL OF EVIDENCE: Level IV, retrospective series. Copyright 2010 Elsevier Masson SAS. All rights reserved.