Background
Ankle sprains are the most common musculoskeletal injuries that occur in athletes. Although often considered minor, they can lead to development of chronic anterolateral soft-tissue ankle impingement. This ankle sprain if left untreated, owing to repetitive actions, can lead to development of thickenings ‘pathological synovial or capsular tissue’ within the ankle joint, which causes persistent painful limitation of ankle movement as a result of entrapment of this pathological tissues in the anterolateral aspect of the joint. As impingement progresses, movements essential to athletes may become impossible; therefore, successful arthroscopic ankle debridement and impinged-soft tissue excision is the procedure of choice, allowing athletes to return fast to their previous preinjury sports activities level.
Patients and methods
A total of 25 elite athletes complaining of persistent anterolateral ankle pain during sports participation, who were diagnosed by history, physical examination, and magnetic resonance imaging to have anterolateral ankle impingement with unsuccessful conservative management for at least 6 months, underwent arthroscopic debridement and excision of the anterolateral impinged hypertrophic, inflamed, and scarred soft tissue. Any athlete diagnosed to have associated ankle instability or tibial or talar chondral lesion was excluded from this study.
Results
There were 13 right ankles and 12 left ankles. There were 14 male and 11 female patients. No bilateral cases existed. The mean duration of symptoms till operation was 8.9 months. The mean postoperative follow-up was 15 months. At the final postoperative evaluation, 23 athletes were satisfied and reparticipated in the same preinjury sports activities level without complaints, whereas two (8%) athletes were unsatisfied and retired from high-level sports activities. The mean time to return to full sports activities with high performance was 8 weeks. According to American Orthopaedic Foot and Ankle Society (AOFAS) at the final postoperative follow-up evaluation, nine patients had excellent results, 14 patients had good results, and two patients had fair results. A significant improvement of the AOFAS (<0.05) was seen at the final postoperative evaluation. Four athletes had reinversion injuries within 4 months postoperatively. Two of them had fair AOFAS results at the final postoperative evaluation. There were no postoperative complications.
Conclusion
Ankle arthroscopy is a useful and safe method in diagnosis and treatment of anterolateral soft tissue ankle impingement in elite athletes, with early return to full sports activities. Final outcome may be affected negatively with new inversion injuries during the early postoperative period.