Introduction Most often caused by osteophyte impingement in anterior tibiotalar joint Can also be caused by excessive anterolateral soft tissues or posterior soft tissue or osseous abnormalities Epidemiology common in athletes who play on turf or on grass including rugby football dancers soccer Mechanism repetitive overuse injuries trauma degenerative sequelae Presentation Symptoms pain in anterior ankle Physical exam pain with forced dorsiflexion limited dorsiflexion soft tissue swelling and effusion may be evident subtalar joint is pain free Imaging Radiographs recommended views AP, lateral, and oblique findings spurs seen in anterior distal tibia or dorsal aspect of the talus oblique views are beneficial in revealing anteromedial talar spurs CT delineates extent of bony osteophytes MRI shows spurring and fluid in joint Treatment Nonoperative therapy, lifestyle modifications, NSAIDS indications first line of treatment corticosteroid injections help with soft tissue impingement and synovitis-related pain Operative arthroscopic excision indications nonoperative modalities fail Techniques Arthroscopic excision supine position with external traction device and leg over a padded bump use knife to only cut the skin and use hemostat to spread to avoid neurovascular injury while making portals ensure adequate field of view prior to burring or shaving anterior distal tibia to avoid iatrogenic dorsal NV bundle injury Complications Superficial peroneal nerve injury during anterolateral portal creation Saphenous vein injury during anteromedial portal creation Dorsal neurovascular bundle injury during tibiotalar spur removal
QUESTIONS 1 of 3 1 2 3 Previous Next (OBQ05.126) A 28-year-old rugby player has had anterior ankle pain for several years. On physical exam he has painful and limited dorsiflexion of the ankle. Based on a dorsiflexed ankle radiograph shown in figure A, what is the most appropriate operative treatment? Review Topic QID: 1012 FIGURES: A 1 Arthroscopic chondral drilling 2% (38/2470) 2 Arthroscopic tibial debridement 90% (2232/2470) 3 Modified Brostrom procedure 1% (32/2470) 4 Arthroscopic os trigonum excision 6% (148/2470) 5 Arthroscopic tibiotalar arthrodesis 0% (9/2470) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ12.194) A 34-year-old active duty military officer has lateral right ankle pain with running during physical training that is worsening over the past 6 months. He recalls sustaining an ankle sprain 3 years ago that resolved with physical therapy. On examination the skin is intact and the talar drawer test is normal. He has pain anterolaterally with end-arc passive dorsiflexion and no pain posteriorly with passive plantarflexion. He has no tenderness on palpation at the distal fibula, anterior talofibular ligament, calcaneofibular ligament. An axial MR arthrogram of the ankle is shown in Figure A. What is the next most appropriate step in management following recalcitrant pain despite conservative management? Review Topic QID: 4554 FIGURES: A 1 Ankle arthropscopy with synovial debridement 54% (1440/2646) 2 Open Brostrom ligament repair with Gould modification 19% (496/2646) 3 Chrisman-Snook tendon transfer 5% (126/2646) 4 Syndesmosis reduction and screw fixation 8% (216/2646) 5 Ankle arthroscopy with loose body removal 13% (347/2646) ML 4 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ08.198) The current body of available evidence supports the use of ankle arthroscopy for all of the following indications EXCEPT: Review Topic QID: 584 1 Ankle arthrodesis 27% (447/1646) 2 Debridement of diffuse degenerative ankle cartilage 70% (1146/1646) 3 Osteochondral lesions 1% (10/1646) 4 Anterior ankle impingement 2% (34/1646) 5 Loose body removal 0% (4/1646) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 2