title: Arthroscopic treatment of anterior ankle impingement: a prospective study of 46 patients with 5-year follow-up.
abstract: BACKGROUND
  Midterm outcomes after arthroscopic debridement in patients with anterior ankle impingement without osteoarthritis are currently unclear.
  
  
  OBJECTIVE
  To assess the functional and radiological outcomes after arthroscopic treatment of anterior ankle impingement with a minimum 5-year follow-up in patients without osteoarthritis.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  From September 1999 to March 2006, a consecutive series of eligible patients without ankle osteoarthritis and with anterior ankle impingement, who had persistent ankle pain and activity restrictions despite at least 6 months of nonoperative management, underwent standardized arthroscopic debridement and followed uniform postoperative management. Patients were assessed preoperatively and at 6 weeks, 6 months, and 12 months and then at 1-year intervals after surgery until a minimum of 5 years' follow-up had been achieved, with weightbearing ankle dorsiflexion, Foot Functional Index (FFI), and plain radiography including Scranton and McDermott classification (SMC) grade and tibial osteophyte size.
  
  
  RESULTS
  A total of 46 patients (42 male, 4 female) were prospectively assessed, with a mean age at surgery of 29 years (range, 16-44 years) and a mean follow-up duration of 5.1 years (range, 5.0-7.5 years). Preoperative ankle radiographs demonstrated a median SMC grade of 2 and a mean tibial osteophyte size of 5.1 mm. At a minimum of 5 years postoperatively, patients demonstrated limited improvement in ankle dorsiflexion (mean, 24.7° [preoperatively] vs 27.0° [final follow-up]; P = .049); however, they demonstrated substantial improvement in the FFI (mean, 20.5 [preoperatively] vs 2.7 [final follow-up]; P < .001). Postoperatively, 84% of patients showed a recurrence of radiological osteophytes, with plain radiographs at final follow-up demonstrating no significant difference in the SMC grade (P = .107) or tibial osteophyte size (P = .212) compared with preoperative imaging. There was no significant effect of patient age, sex, body mass index, or SMC grade at the time of surgery on any of the postoperative outcome measures.
  
  
  CONCLUSIONS
  In this prospective outcome study of 46 patients without osteoarthritis managed arthroscopically for anterior ankle impingement, the functional outcome scores had significantly improved at 5 years postoperatively despite a recurrence of radiographic osteophytes.
authors.affiliation: Unisports Sports Medicine, Auckland, New Zealand.
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Walsh
authors.affiliation: Unisports Sports Medicine, Auckland, New Zealand Sports Medicine Center at Husky Stadium, Seattle, Washington, USA.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Twaddle
authors.affiliation: Unisports Sports Medicine, Auckland, New Zealand.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Rosenfeldt
authors.affiliation: Unisports Sports Medicine, Auckland, New Zealand drmattboyle@hotmail.com.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Boyle
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018771:Arthralgia / Q000209:etiology; D001182:Arthroscopy; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D054850:Osteophyte / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012008:Recurrence; D012720:Severity of Illness Index; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: ankle arthroscopic surgery; ankle impingement; athletes; functional outcomes