Updated: 6/8/2021

Tibiotalar Impingement

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
1
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
18
0
0
0%
0%
Videos / Pods
1
Topic
Images
https://upload.orthobullets.com/topic/7035/images/Xray - lateral - colorado_moved.png
https://upload.orthobullets.com/topic/7035/images/MRI_moved.JPG
  • summary
    • Tibiotalar Impingement is a source of anterior ankle pain that is most often caused by osteophyte impingement in the anterior tibiotalar joint.
    • Diagnosis is made clinically with anterior ankle pain that worsens with forced dorsiflexion. Radiographs often show spurs in the anterior distal tibia or dorsal aspect of the talus.
    • Treatment is a trial of activity modifications, NSAIDs and corticosteroid injections. Surgical management is indicated in patients with progressive symptoms who fail nonoperative management.
  • Epidemiology
    • Demographics
      • common in athletes who play on turf or on grass including
        • rugby
        • football
        • dancers
        • soccer
  • Etiology
    • Mechanism
      • repetitive overuse injuries
      • trauma
      • degenerative sequelae
      • can also be caused by excessive anterolateral soft tissues or posterior soft tissue or osseous abnormalities
  • 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
        • 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

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (1)
Cards
1 of 1
Questions (5)

(OBQ17.168) A 27-year-old rugby player returns to clinic noting persistent ankle pain. He endorses a history of vague ankle issues but none that required missed competition time. His pain is located anteriorly and worsens when in a crouched position. Exam shows point tenderness at the anterior joint line, and passive dorsiflexion to 10° reproduces his pain. Which structure is unlikely to be a potential source of pain in this condition?

QID: 210255
1

Anterior inferior tibiofibular ligament

12%

(197/1670)

2

Tibial osteophyte

19%

(323/1670)

3

Accessory ossification near the posterolateral talar process

54%

(904/1670)

4

Inflamed synovium and capsular tissues

6%

(106/1670)

5

Talar neck exostosis

7%

(125/1670)

L 3 A

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(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?

QID: 4554
FIGURES:
1

Ankle arthropscopy with synovial debridement

54%

(1704/3182)

2

Open Brostrom ligament repair with Gould modification

19%

(618/3182)

3

Chrisman-Snook tendon transfer

5%

(169/3182)

4

Syndesmosis reduction and screw fixation

8%

(257/3182)

5

Ankle arthroscopy with loose body removal

13%

(405/3182)

L 4 C

Select Answer to see Preferred Response

(OBQ08.198) The current body of available evidence supports the use of ankle arthroscopy for all of the following indications EXCEPT:

QID: 584
1

Ankle arthrodesis

28%

(616/2211)

2

Debridement of diffuse degenerative ankle cartilage

69%

(1519/2211)

3

Osteochondral lesions

1%

(13/2211)

4

Anterior ankle impingement

2%

(50/2211)

5

Loose body removal

0%

(6/2211)

L 3 C

Select Answer to see Preferred Response

(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?

QID: 1012
FIGURES:
1

Arthroscopic chondral drilling

2%

(60/3512)

2

Arthroscopic tibial debridement

89%

(3119/3512)

3

Modified Brostrom procedure

1%

(49/3512)

4

Arthroscopic os trigonum excision

7%

(242/3512)

5

Arthroscopic tibiotalar arthrodesis

1%

(27/3512)

L 1 C

Select Answer to see Preferred Response

Evidence (18)
VIDEOS & PODCASTS (2)
EXPERT COMMENTS (8)
Private Note