Advertisement

Bony Impingement: Aetiology, Classifications, Treatment, Arthroscopic Procedures, Pitfalls and Tricks

  • Fabrizio Cortese
  • Domenico Mercurio
  • Maria Pia Pasquali
  • Piero Giardini
Chapter
  • 37 Downloads

Abstract

Ankle bony impingement syndrome refers to abnormal entrapment or contact of structures resulting in pain and restricted motion. Anterior ankle impingement syndrome is very common in athletes who perform repeated ankle dorsiflexions (football players, American football players, dancers, gymnasts and runners). Aetiopathogenesis is related to repeated sprains, chronic instability and repeated microtraumas associated with the formation of osteophytes. Posterior bony impingement syndrome affect athletes like dancer that iterate forced platar-flexions. The posterior bone conflict is created between the posterior edge of the talus and the posterior edge of the tibia. The talus is posteriorly characterised by posterolateral and posteromedial processes. between theese two structures there is the groove of Flexor Hallucis Longus (FHL) tendon. The anatomical relationship between the posterolateral process and the FHL often results in association of bone conflict syndromes with FHL tendinopathy. In this chapter we discuss classifications, diagnostic workup and arthroscopic treatment of bony impingement.

Supplementary material

Video 5.1

Anterior bony impingement(MP4 50827 kb)

Video 5.2

Posterior bony impingement (MP4 150596 kb)

References

  1. 1.
    Van Dijk CN, Bossuyt PM, Marti RK. Medial ankle pain after lateral ligament rupture. J Bone Joint Surg Br. 1996;78:562–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Ferkel RD. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med. 1991;19:440–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Hess GW. Ankle impingement syndromes:a review of etiology and related implications. Foot Ankle. 2011;4:290–7.Google Scholar
  4. 4.
    Talusan PG, Toy J, Perez JL, Milewski MD, Reach JS Jr. Anterior ankle impingement: diagnosis and treatment. J Am Acad Orthop Surg. 2014;22:333–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Morris LH. Athlete’s ankle. J Bone Joint Surg Am. 1943;25:220.Google Scholar
  6. 6.
    McMurray TP. Footballer’s ankle. J Bone Joint Surg. 1950;32:68–9.CrossRefGoogle Scholar
  7. 7.
    O’Kane JW, Kadel N. Anterior impingement syndrome in dancers. Curr Rev Musculoskelet Med. 2008;1:12–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Biedert R. Anterior ankle pain in sports medicine: aetiology and indications for arthroscopy. Arch Orthop Trauma Surg. 1991;110:293–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Cutsuries AM, Saltrick KR, Wagner J. Arthroscopic arthroplasty of the ankle joint. Clin Podiatr Med Surg. 1994;11:449–67.PubMedGoogle Scholar
  10. 10.
    Ferkel RD, Fasulo GJ. Arthroscopic treatment of ankle injuries. Orthop Clin North Am. 1994;25:17–32.PubMedGoogle Scholar
  11. 11.
    Lijoi F. Ankle impingement (anterior and posterior). In: Volpi P, editor. Arthroscopy and sport injuries applications in high-level athletes, vol. 51. New York, NY: Springer; 2016. p. 405–12.Google Scholar
  12. 12.
    Tol JL, van Dijk CN. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle Int. 2004;25:382–6.PubMedCrossRefGoogle Scholar
  13. 13.
    van Dijk CN, Verhagen RA, Tol JL. Arthroscopy for problems after ankle fracture. J Bone Joint Surg Br. 1997;79:280–4.PubMedCrossRefGoogle Scholar
  14. 14.
    van Dijk CN, Wessel RN, Tol JL, Maas M. Oblique radiograph for the detection of bone spurs in anterior ankle impingement syndrome A biomechanical analysis. Am J Sports Med. 2002;30:45–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Lavery KP, McHale KJ, Rossy WH, Theodore G. Ankle impingement. J Orthop Surg Res. 2016;11:97.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Hess GW. Ankle impingement syndromes: a review of etiology and related implications. Foot Ankle Spec. 2011;4:290–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Scranton PE, McDermott JE. Anterior tibiotalar spurs: a comparison of open versus arthroscopic debridement. Foot Ankle. 1992;13:125–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Vaseenon T, Amendola A. Update on anterior ankle impingement. Curr Rev Musculoskelet Med. 2012;5(2):145–50.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Stibbe AB, et al. The OS trigonum syndrome. Acta Orthop Scand Suppl. 1994;262:59–60.Google Scholar
  20. 20.
    Scholten PE, Sierevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am. 2008;90:2665–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Quirk R. Common foot and ankle injuries in dance. Orthop Clin North Am. 1994;25:123–33.PubMedGoogle Scholar
  22. 22.
    Uzel M, Cetinus E, Bilgic E, Karaoguz A, Kanber Y. Bilateral os trigonum syndrome associated with bilateral tenosynovitis of the flexor hallucis longus muscle. Foot Ankle Int. 2005;26:894–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Nickisch F, Barg A, Saltzman CL. Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am. 2012;94:439–46.PubMedCrossRefGoogle Scholar
  24. 24.
    Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy. 2008;24:196–202.PubMedCrossRefGoogle Scholar
  25. 25.
    Theodoulou MH, Bohman L. Arthroscopic approach to posterior ankle impingement. Clin Podiatr Med Surg. 2016;33:531–43.PubMedCrossRefGoogle Scholar
  26. 26.
    van Dijk CN. Anterior and posterior ankle impingement. Foot Ankle Clin. 2006;11:663–83.CrossRefGoogle Scholar
  27. 27.
    Youichi Y, Charles PH, Eoghan H, John GK. Posterior ankle impingement syndrome: a systematic four-stage approach. World J Orthop. 2016;7:657–63.CrossRefGoogle Scholar
  28. 28.
    Umans H. Ankle impingement syndromes. Semin Musculoskelet Radiol. 2002;6:133–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Hedrick MR, McBryde AM. Posterior ankle impingement. Foot Ankle Int. 1994;15:2–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Lawson JP. Symptomatic radiographic variants in extremities. Radiology. 1985;157:625–31.PubMedCrossRefGoogle Scholar
  31. 31.
    Wiegerinck JI. The posterior impingement view: an alternative conventional projection to detect bony posterior ankle impingement. Arthroscopy. 2014;30:1311–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Bureau NJ, Cardinal E, Hobden R, Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients. Radiology. 2000;215:497–503.PubMedCrossRefGoogle Scholar
  33. 33.
    Best A, Giza E, Linklater J, Sullivan M. Posterior impingement of the ankle caused by anomalous muscles. A report of four cases. J Bone Joint Surg Am. 2005;87:2075–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. 2004;32:1385–93.PubMedCrossRefGoogle Scholar
  35. 35.
    Albisetti W, Ometti M, Pascale V, De Bartolomeo O. Clinical evaluation and treatment of posterior impingement in dancers. Am J Phys Med Rehabil. 2009;88:349–54.PubMedCrossRefGoogle Scholar
  36. 36.
    Soler T, Jezerskyte Banfi R, Katsmen L. The conservative treatment of posterior ankle impingement syndrome in professional ballet dancers: a literature review and experts consensus. Amsterdam: European School of Physiotherapy; 2011.Google Scholar
  37. 37.
    Ribbans WJ. The management of posterior ankle impingement syndrome in sport: a review. Foot Ankle Surg. 2015;21:1–10.PubMedCrossRefGoogle Scholar
  38. 38.
    Marotta JJ, Micheli LJ. Os trigonum impingement in dancers. Am J Sports Med. 1992;20:533–6.PubMedCrossRefGoogle Scholar
  39. 39.
    van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000;16:871–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Noguchi H, Ishii Y, Takeda M. Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results. Foot Ankle Int. 2010;31:398–403.PubMedCrossRefGoogle Scholar
  41. 41.
    Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot Ankle Surg. 2011;17:79–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Zwiers R. Surgical treatment for posterior ankle impingement. Arthroscopy. 2013;29:1263–70.PubMedCrossRefGoogle Scholar
  43. 43.
    Sitler DF, Amendola A, Bailey CS, Thain LM, Spouge A. Posterior ankle arthroscopy: an anatomic study. J Bone Joint Surg Am. 2002;84:763–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Sora MC, Jilavu R, Grubl A. The posteromedial neuro-vascular bundle of the ankle: an anatomic study using plasti-nated cross sections. Arthroscopy. 2008;24:258–63.PubMedCrossRefGoogle Scholar
  45. 45.
    Weiss WM. Arthroscopic excision of a symptomatic os trigonum. Arthroscopy. 2015;31:2082–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Lui TH. Arthroscopic treatment of posterior ankle impingement in the supine position using coaxial posterior portals. Foot Ankle Int. 2014;3:834–7.CrossRefGoogle Scholar
  47. 47.
    Gasparetto F, Collo G, Pisanu G, Villella D, Drocco L, Cerlon R, Bonasia DE. Posterior ankle and subtalar arthroscopy: indications, technique, and results. Curr Rev Musculoskelet Med. 2012;5:164–70.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Fabrizio Cortese
    • 1
  • Domenico Mercurio
    • 1
  • Maria Pia Pasquali
    • 1
  • Piero Giardini
    • 2
  1. 1.Department of Orthopaedics and TraumatologyOspedale Santa Maria del CarmineRoveretoItaly
  2. 2.Orthopaedic DepartmentUniversity of UdineUdineItaly

Personalised recommendations