title: Os Trigonum Excision in Dancers via an Open Posteromedial Approach.
abstract: BACKGROUND
  An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Options for operative excision include open excision, subtalar arthroscopy, and posterior endoscopy. The purpose of this paper was to present a series of dancers who underwent excision of a symptomatic os trigonum via an open posteromedial approach.
  
  
  METHODS
  This study is a retrospective case series of 40 ankles in 38 dancers who underwent os trigonum excision via an open posteromedial approach with FHL tenolysis between 2000 and 2013. All patients were interviewed and charts retrospectively analyzed. Collected variables included pre- and postoperative pain level, time to return to dance, and subjective satisfaction. The average age was 19.2 years; ballet was the primary dance form in 36 (95%) of patient-cases. Eight (20%) of the patient-cases were professional dancers, and 30 (75%) were students or preprofessional dancers.
  
  
  RESULTS
  Average preoperative pain level was 7.7/10, which decreased to 0.6/10 postoperatively. Seventeen (42.5%) experienced concurrent preoperation-associated FHL symptomatology, all of whom experienced relief postoperatively. The average time to return to dance was 7.9 weeks, and time to pain-free dance was 17.7 weeks. Of the 37 patient-cases desiring to return to dance, 35 (94.6%) returned to their preoperative level of dance. There were no neurovascular or other major complications. Four (10%) had minor wound complications that resolved, and 38 cases (95%) considered the procedure a success.
  
  
  CONCLUSIONS
  Open posteromedial excision of an os trigonum in dancers provided satisfactory pain relief, return to dance, and complication rates compared to other approaches, and allowed for identifying and treating any associated FHL pathology.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 Orthopaedic Surgery Department, George Washington University Hospital, Washington, DC, USA.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Heyer
authors.affiliation: 2 Department of Orthopaedic Surgery, Harkness Center for Dance Injuries, New York University Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D003615:Dancing; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000601:surgery; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D013628:Talus / Q000002:abnormalities* / Q000601:surgery*; D055815:Young Adult
keywords: Os trigonum; dance injuries; posterior ankle impingement syndrome