Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula)

Eung-Soo Kim; Chang-Rak Lee; Young-Jun Kim; Sang-Myung Roh; Jae-Keun Park; Heui-Chul Gwak; Sun-Gyu Jung

doi:10.14193/jkfas.2017.22.1.26

Journal List > J Korean Foot Ankle Soc > v.22(1) > 1104572

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Kim, Lee, Kim, Roh, Park, Gwak, and Jung: Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula)

Original Article

J Korean Foot Ankle Soc 2018;22(1):26-31.

Published online: 19 January 2018

DOI: https://doi.org/10.14193/jkfas.2017.22.1.26

Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula)

Eung-Soo Kim, Chang-Rak Lee^*, Young-Jun Kim^*, Sang-Myung Roh^*, Jae-Keun Park^†, Heui-Chul Gwak^*, Sun-Gyu Jung^*

Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Korea

^*Department of Orthopedic Surgery, Gwangmyeong Saeum Hospital, Gwangmyeong, Korea

^†Department of Orthopedic Surgery, Dongrae Bongseng Hospital, Busan, Korea

Corresponding Author: Heui-Chul Gwak Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6129, Fax: 82-51-890-6619, E-mail: ortho1@hanmail.net ORCID: http://orcid.org/0000-0003-1062-0580

Received 13 April 201723 October 2017 Accepted 20 November 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study is to compare the clinical results between two different methods of hindfoot endoscopy to treat posterior ankle impingement syndrome.

Materials and Methods:

Between January 2008 and January 2014, 52 patients who underwent hindfoot endoscopy were retrospectively reviewed. Two methods of hindfoot endoscopy were used; Group A was treated according to van Dijk and colleagues’ standard two-portal method, and group B was treated via the modified version of the above, using a protection cannula. For clinical comparison, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, time required to return to activity, and the presence of complications were used.

Results:

There was no statistically significant difference in the AOFAS scores at the final follow-up, and there was also no statistically significant difference in the times for the scores to return to the preoperative level. There were no permanent neurovascular injuries and wound problems in either group.

Conclusion:

Use of protection cannula may provide additional safety during hindfoot endoscopy. We could not prove whether protection cannula can provide superior safety for possible neurovascular injury. Considering the possible safety and risk of using additional instrument, the use of this method may be optional.

Keywords: Hindfoot, Endoscopy, Os trigonum

REFERENCES

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Figure 1.

Simple lateral radiograph of ankle revealed osteophyte of posterior aspect of the talus on lateral view (arrow).

Figure 2.

Magnetic resonance images showing prominent osteophyte at posterior aspect of the talus at saggital view (A; arrow) and at axial view (B; arrow).

Figure 3.

Note the posteromedial cannula inserted for safety (A; arrow), and the cannula can be used for retracting and protecting the surrounding soft tissue, including the neurovascular bundle (B). v.: vein, FHL: flexor hallucis longus tendon, Med.: medial, Lat.: lateral, n.: nerve, Post.: posterior, a.: artery.

Figure 4.

The osteophyte and the loose body were visualized (A) and removed (B) through the posteromedial portal with a protection cannula.

Figure 5.

Postoperative radiograph. Osteophyte was removed on lateral view (arrow).

Table 1.

Preoperative Demographic Data in Both Groups

	Group A (n=25)	Group B (n=27)	p-value
Age (yr)	23.8±10.5 (15∼45)	33.8±14.4 (17∼56)	0.0502*
Sex (M:F)	14:11	16:11	0.8139^†
Baseline AOFAS score	61±9	60±9	0.3435*
Follow-up period (mo)	38.5±19.3 (24∼84)	27.7±5.9 (24∼42)	0.0283*

Values are presented as mean±standard deviation (range), number only, or mean±standard deviation.

Group A was treated according to van Dijk et al.’s standard two-portal method,⁶⁾ and group B was treated by a modification of the same method, using a protection cannula.

M: male, F: female, AOFAS: American Orthopaedic Foot and Ankle Society. *Mann-Whitney U-test.

^† Chi-square test.

Table 2.

The Comparison of the AOFAS Score between the Preoperative and Postoperative Periods in Each Group

	Preoperative period	Postoperative period	p-value
AOFAS in group A (n=25)	61±9	96±5	<0.0000*
AOFAS in group B (n=27)	60±9	94±5	<0.0000*

Values are presented as mean±standard deviation.

Group A was treated according to van Dijk et al.’s standard two-portal ⁶⁾ method,⁶⁾ and group B was treated by a modification of the same method, using a protection cannula.

AOFAS: American Orthopaedic Foot and Ankle Society. *Wilcoxon signed rank test.

Table 3.

The Time to Return to Activity in Both Groups

Group A (n=25)	Group B (n=27)	p-value
Time (mo) 10.9±2.1 (8.3∼15.3)	11.3±3.3 (7.5∼18.5)	) 0.8397*

Values are presented as mean±standard deviation (range). Group A was treated according to van Dijk et al.’s standard two-portal method,⁶⁾ and group B was treated by a modification of the same method, using a protection cannula. *Mann-Whitney U-test.

significant difference (p=0.8397) (Table 3).

Table 4.

Postoperative Complications in Both Groups

	Group A (n=25)	Group B (n=27)
Incision anesthesia	0	1
Medial calcaneal neuritis	0	0
Superficial peroneal neuritis	0	0
Sural neuritis	1	0
Sinus tract formation	0	0
Infection	0	0
Superficial	0	0
Deep	0	0
Injection for recurrent symptoms	0	0
Reoperation for recurrent symptoms	0	0

Group A was treated according to van Dijk et al.’s standard two-portal method, 6) and group B was treated by a modification of the same method, using a protection cannula.

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