Purpose of the study: Many hind foot problems can be treated by endoscopic procedures. It is essential to identify the best candidates for this treatment and also to assess the risk associated with these surgeries. Here we present our first experience with posterior ankle arthroscopy.
Material and methods: Between September 2007 and September 2009, we performed 21 arthroscopic procedures on the posterior ankle (one-stage combined anterior and posterior surgery, 11x; posterior procedure, 7x; two-stage anterior and posterior surgery, 3x). The group included 21 patients, 18 men and three women, with an average age of 36 years (20 to 64) at the time of surgery. The average follow-up was 27 months (16 to 38). Both posterolateral and posteromedial approaches were used, with major landmarks being the processus posterior tali, posterior talofibular ligament and long flexor tendon of the big toe. Surgery was performed by experienced specialists. Outcome evaluation was based on the AOFAS and Kitaoka clinical rating scales and the complication rate.
Results: In our group, the diagnoses treated by arthroscopic surgery were as follows: arthrofibrosis (16x; 76 %), hypertrophic processus posterior tali (13x; 62 %), and loose intra-articular bodies (8x; 38 %). All patients reported improvement in clinical condition after surgery. The differences between the mean pre- and post-operative values were 24 points for the AOFAS score (58 versus 82; p<0.00015) and 23 points for the Kitaoka score (58 versus 81; p < 0.00015). The most effective outcomes were achieved in the patients operated on for loose bodies or hypertrophic processus posterior tali. The worst result was found in the patient with advanced arthritis of the ankle that had to undergo arthrodesis 13 months following arthroscopic treatment. There were eight complications in five patients (24 %), including excessive bleeding in five cases, temporary loss of sensation in two, and a damaged tendon of the long flexor of the big toe.
Discussion: Arthroscopic surgery has recently been advocated by many authors. The majority of them have reported good results and an acceptable risk of complications. Almost all use either the posteromedial or the lateral approach, which are anatomically safe procedures. Surgery is followed by a thorough rehabilitation programme that allows most patients to resume their normal daily activities in 8 weeks. Our results were not so good because we mostly treated post-traumatic conditions, with advanced ankle arthritis in several patients.
Conclusions: Arthroscopy is an effective method for treating both intra- and extra-articular pathologies in the posterior ankle. The best effect of treatment was recorded in posterior tibiotalar impingement syndrome or after extraction of loose intra-articular bodies. In advanced ankle arthritis, on the other hand, the use of arthroscopic treatment should be carefully considered. The risk of complications is high and the procedure requires good knowledge of anatomy and high surgical skills.