title: Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results.
abstract: BACKGROUND
  We treated 12 cases of posterior ankle bony impingement in 12 athletes arthroscopically, and examined the operating methods, findings, and postoperative physical therapy and overall results.
  
  
  METHODS
  The patients' average age was 21.4 years. The mean duration of postoperative followup was 33.8 months. A 2.7-mm, 30 degree arthroscope was inserted into the subtalar joint using posterolateral and accessory posterolateral portals. When the impinged fragment was visualized, it was carefully excised from the surrounding soft tissues. The operation was completed once the entire flexor hallucis longus tendon was seen. No cast immobilization was applied postoperatively, and physical therapy including limited weight bearing and range-of-motion exercises commenced within 24 hours after surgery. Beginning 3 weeks after surgery, the patients were permitted to gradually resume sports under the guidance of a physiotherapist. The AOFAS ankle-hindfoot score, the postoperative range of motion of the ankle and the time to recover were determined.
  
  
  RESULTS
  The average postoperative AOFAS ankle-hindfoot score improved from 68.0 to 98.3 points. The mean preoperative range of motion of the ankle joint was improved from 59.2 degree to 68.4 degree. The average period to return to sports was 5.9 weeks. All patients reached full activity within 13 weeks after surgery. The surgical time ranged from 40 minutes to over 2 hours and was affected by the impingement condition.
  
  
  CONCLUSIONS
  Arthroscopic treatment for posterior ankle bony impingement syndrome was minimally invasive and suitable for athletes who desire an early return to sports activity.
authors.affiliation: Ishii Orthopaedic and Rehabilitation Clinic, Orthopaedic Surgery, Gyoda, Saitama 361-0037, Japan. hid_166super@mac.com
authors.forename: Hideo
authors.initials: H
authors.lastname: Noguchi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishii
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takeda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Monden
authors.forename: Kenji
authors.initials: K
authors.lastname: Takagishi
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy; D001265:Athletic Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult