title: Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series.
abstract: BACKGROUND
  Hindfoot arthroscopic surgery has been described as a minimally invasive surgical treatment for posterior ankle impingement syndrome. The current article describes a systematic approach for identifying relevant hindfoot structures as well as the clinical results of a case series.
  
  
  OBJECTIVE
  To present a structured systematic surgical approach for identifying relevant anatomic structures and abnormalities during hindfoot arthroscopic surgery. In addition, we report the clinical results of a case series.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The systematic surgical approach divides the extra-articular structures of the hindfoot into quadrants as defined by the intermalleolar ligament. Twenty-two patients underwent hindfoot arthroscopic surgery for the treatment of posterior ankle impingement syndrome. The mean follow-up time was 25 months (range, 14-35 months). Standard patient-reported outcome questionnaires of the foot and ankle outcome score (FAOS) and Short Form-12 (SF-12) general health survey were administered at standard time points after surgery. Return to sporting activities was also calculated as the time period from the date of surgery until the patient was able to participate at their previous level of activity.
  
  
  RESULTS
  The mean FAOS score improved from 59 (range, 22-94) preoperatively to 86 (range, 47-100) postoperatively (P < .01). The mean SF-12 score showed similar improvement with a mean of 66 (range, 42-96) preoperatively to 86 (range, 56-98) postoperatively (P < .01). Nineteen patients reported competing at some level of athletic sport before surgery. All patients returned to their previous level of competition after surgery. The mean time to return to sporting activities was 12 weeks (range, 6-16 weeks). Two complications were reported postoperatively: 1 wound infection and 1 case of dysesthesia of the deep peroneal nerve.
  
  
  CONCLUSIONS
  Hindfoot arthroscopic surgery is a safe and effective treatment strategy for posterior ankle impingement syndrome. In addition, it allows the patients a rapid return to sporting activities.
authors.affiliation: Hospital for Special Surgery, 535 East 72nd Street, New York, NY 10021, USA. SmythN@hss.edu
authors.forename: Niall A
authors.initials: NA
authors.lastname: Smyth
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
authors.forename: David S
authors.initials: DS
authors.lastname: Levine
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: arthroscopic surgery; hindfoot; impingement; posterior ankle