Arthrosis

Abstract

Chronic activity related ankle pain due to tibiotalar osteophytes at the anterior aspect of the ankle joint, which results in anterior impingement syndrome (so-called “soccer’s ankle” or “athletes ankle”).

Repetitive mechanical stress is believed to be the cause of this pathological condition. This occurs mainly with repetitive distraction of the capsuloligamentous structures, as for example in shooting the ball in soccer (with plantar flexion of the ankle) and represents the basic factor behind the formation of tibiotalar osteophytes. The definitive cause for the formation of osteophytes is however controversial.

The pain seems to result from irritation and inflammation of the soft tissues surrounding the osteophytes, but not the osteophytes themselves. Repetitive trauma to the soft tissue by the osteophytes leads to synovial hypertrophy and inflammatory cell infiltration.

Theoretically, removal of the soft tissue should eliminate the pain. However, the pathomechanical process will not be interrupted if the osteophytes are not addressed.

Resection of the anterior tibial osteophytes and those on the talar neck as well as removal of the synovial villi.

Resection of the osteophytes can be open or arthroscopically performed. The open approach has the disadvantage of possible injury to the cutaneous braches of the superficial peroneal nerve, wound healing problems, hypertrophied scar tissue, and injury to the long extensor tendons, which is why the authors prefer the arthroscopic approach.