Research Article
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Year 2023, Volume: 9 Issue: 1, 155 - 163, 04.01.2023
https://doi.org/10.18621/eurj.1213036

Abstract

References

  • 1. Van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 2000;16:871-6.
  • 2. Hayashi D, Roemer FW, D’Hooghe P, Guermazi A. Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses. Eur J Radiol 2015;84:2231-41.
  • 3. Gökkuş K, Gökkuş K, Aydın AT. Posterior ankle and hindfoot arthroscopy: indications and results. Orthop Sports Med 2014;2(3 Supply):2325967114S00206.
  • 4. Tonogai I, Sairyo K. Posterior arthroscopic treatment of a massive effusion in the flexor hallucis longus tendon sheath associated with stenosing tenosynovitis and os trigonum. Case Rep Orthop 2020;2020:6236302.
  • 5. Nikolopoulos D, Safos G, Moustakas K, Sergides N, Safos P, Siderakis A, et al. Endoscopic treatment of posterior ankle impingement secondary to os trigonum in recreational athletes. Foot Ankle Orthop 2020;5:2473011420945330.
  • 6. Reddy VK. Os trigonum syndrome. Int J Biomed Adv Res 2015;6:60-3.
  • 7. Kudaş S, Dönmez G, Işık Ç, Çelebi M, Çay N, Bozkurt M. Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes. Acta Orthop Traumatol Turc 2016;50:649-54.
  • 8. Lui TH. Flexor hallucis longus tendoscopy: a technical note. Knee Surg Sports Traumatol Arthrosc 2009;17:107-10.
  • 9. Gursoy M, Dirim Mete B, Cetinoglu K, Bulut T, Gulmez H. The coexistence of os trigonum, accessory navicular bone and os peroneum and associated tendon and bone pathologies. Foot (Edinb) 2021;50:101886.
  • 10. Corte-Real NM, Moreira RM, Guerra-Pinto F. Arthroscopic treatment of tenosynovitis of the flexor hallucis longus tendon. Foot Ankle Int 2012;33:1108-12.
  • 11. Donovan A, Rosenberg ZS. MRI of ankle and lateral hindfoot impingement syndromes. AJR Am J Roentgenol 2010;195:595-604.
  • 12. Nault ML, Kocher MS, Micheli LJ. Os trigonum syndrome. J Am Acad Orthop Surg 2014;22:545-53.
  • 13. Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, Van Dijk CN, et al. Posterior hindfoot arthroscopy: a review. Am J Sports Med 2014;42:225-34.
  • 14. Smyth NA, Murawski CD, Levine DS, Kennedy JG. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. Am J Sports Med 2013;41:1869-76.
  • 15. Barchi EI, Swensen S, Dimant OE, McKay TE, Rose DJ. Flexor hallucis longus tenolysis/tenosynovectomy in dancers. J Foot Ankle Surg 2022;61:84-7.
  • 16. Heier KA, Hanson TW. Posterior ankle impingement syndrome. Oper Tech Sports Med 2017;25:75-81.
  • 17. Michelson JD, Bernknopf JW, Charlson MD, Merena SJ, Stone LM. What is the efficacy of a nonoperative program including a specific stretching protocol for flexor hallucis longus tendonitis? Clin Orthop Relat Res 2021;479:2667-76.
  • 18. Ogut T, Ayhan E, Irgit K, Sarikaya AI. Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 2011;19:1355-61.
  • 19. Georgiannos D, Bisbinas I. Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome in an athletic population: a randomized controlled study with 5-year follow-up. Am J Sports Med 2017;45:1388-94.
  • 20. Qu W, Liu T, Chen W, Sun Z, Dong S, Chen M. Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion. J Orthop Surg (Hong Kong) 2019;27:2309499019863355.
  • 21. Mohanty A, Nayak SS, Samanta SK, Biswas R, Mohanty A. Endoscopic excision of os trigonum in symptomatic ballet dancers of odisha - A prospective cohort study. J Evid Based Med Healthc 2020;7:287-91.
  • 22. Kazuya Sugimoto, Shinji Isomoto, Norihiro Samoto, Tomohiro Matsui, Yasuhito Tanaka. Arthroscopic treatment of posterior ankle ımpingement syndrome: mid-Term clinical results and a learning curve. Arthrosc Sports Med Rehabil 2021;3: e1077-86.
  • 23. Spennacchio P, Cucchi D, Randelli PS, Van Dijk NC. Evidence based indications for hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc 2016;24:1386-95.
  • 24. Morelli F, Mazza D, Serlorenzi P, Guidi M, Camerucci E, Calderaro C, et al. Endoscopic excision of symptomatic os trigonum in professional dancers. J Foot Ankle Surg 2017;56:22-5.
  • 25. Pereira H, Batista J, Sousa D, Gomes S, Pereira JP, Ripoll PL. Posterior impingement and os trigonum. In:Canata G, d’Hooghe P, Hunt K, Kerkhoffs G, Longo U. eds., Sports Injuries of the Foot and Ankle. Springer:Berlin, Heidelberg. 2019: pp.191-206.
  • 26.  Funasaki H, Hayashi H, Sakamoto K, Tsuruga R, Marumo K. Arthroscopic release of flexor hallucis longus tendon sheath in female ballet dancers: dynamic pathology, surgical technique, and return to dancing performance. Arthrosc Tech 2015;4:e769-74.
  • 27. Ögüt T, Yontar NS. Treatment of hindfoot and ankle pathologies with posterior arthroscopic techniques. EFORT Open Rev 2017;2:230-40.
  • 28. Ribbans WJ, Ribbans HA, Cruickshank JA, Wood EV. The management of posterior ankle impingement syndrome in sport: a review. Foot Ankle Surg 2015;21:1-10.

Clinical and radiological results of posterior ankle endoscopy treatment for the flexor hallusis longus tenosynovitis and os trigonum syndrome

Year 2023, Volume: 9 Issue: 1, 155 - 163, 04.01.2023
https://doi.org/10.18621/eurj.1213036

Abstract

Objectives: This study investigated the effect of two portal posterior ankle arthroscopy (PAA) procedures using American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) scores for the treatment of patients with ankle pain associated with Os trigonum (OT) and Flexor hallusis longus (FHL) tenosynovitis. The effect of PAA treatment on the degree and localization of effusion around the FHL tendon was also investigated.

Methods: Between March 2016 and August 2021, 41 patients who underwent PAA with the diagnosis of OT and stenosing FHL tenosynovitis, whose arthroscopy video records could be reviewed retrospectively, and who had at least 1 year of follow-up results were included in the study. Patients in the pediatric age group, diabetes patients, patients with inflammatory disease, and those with subtalar and tibiotalar osteoarthritis were excluded from the study. Preoperative and postoperative physical examinations, lateral radiography of the pressing foot, MRI, and the VAS and AOFAS scores were evaluated. In the statistical analysis, data were statistically analyzed using SPSS 19.0 (SPSS, Chicago, Illinois, USA). p < 0.05 was accepted as statistically significant.


Results:
The mean age was 35.6 years (range: 19-55), among which the mean age of the women was 36.2 years (range: 24-48), and the mean age of the men was 35.2 years (range: 19-55). The mean follow-up was 34 months (range: 14-62). The AOFAS value increased from 38.61 ± 7.176 preoperatively to 89.83 ± 6.34 at the postoperative follow-up, and the difference was statistically significant (p < 0.001). Five patients fully regained their normal function (AOFAS score = 100 points). The VAS value increased from 90 ± 5.916 preoperatively to 18.682 ± 7.688 at the last postoperative follow-up, and the difference was statistically significant (p < 0.001). Pre-PAA FHL tenosynovitis was seen only in zone 1 in 26 patients, zones 1 and 2 in 14 patients, and in zones 1, 2, and 3 in two patients. There was no significant decrease in effusion in the magnetic resonance imaging (MRI) at 1 month after the PAA (p = 0.117). A significant decrease in effusion was observed in the MRI taken at the last control (p < 0.001).

Conclusions: In the treatment of patients with ankle pain associated with OT and FHL tenosynovitis, the two-portal PAA treatment was observed to be an effective method that resulted in significant improvement in the AOFAS and VAS scores.

References

  • 1. Van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 2000;16:871-6.
  • 2. Hayashi D, Roemer FW, D’Hooghe P, Guermazi A. Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses. Eur J Radiol 2015;84:2231-41.
  • 3. Gökkuş K, Gökkuş K, Aydın AT. Posterior ankle and hindfoot arthroscopy: indications and results. Orthop Sports Med 2014;2(3 Supply):2325967114S00206.
  • 4. Tonogai I, Sairyo K. Posterior arthroscopic treatment of a massive effusion in the flexor hallucis longus tendon sheath associated with stenosing tenosynovitis and os trigonum. Case Rep Orthop 2020;2020:6236302.
  • 5. Nikolopoulos D, Safos G, Moustakas K, Sergides N, Safos P, Siderakis A, et al. Endoscopic treatment of posterior ankle impingement secondary to os trigonum in recreational athletes. Foot Ankle Orthop 2020;5:2473011420945330.
  • 6. Reddy VK. Os trigonum syndrome. Int J Biomed Adv Res 2015;6:60-3.
  • 7. Kudaş S, Dönmez G, Işık Ç, Çelebi M, Çay N, Bozkurt M. Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes. Acta Orthop Traumatol Turc 2016;50:649-54.
  • 8. Lui TH. Flexor hallucis longus tendoscopy: a technical note. Knee Surg Sports Traumatol Arthrosc 2009;17:107-10.
  • 9. Gursoy M, Dirim Mete B, Cetinoglu K, Bulut T, Gulmez H. The coexistence of os trigonum, accessory navicular bone and os peroneum and associated tendon and bone pathologies. Foot (Edinb) 2021;50:101886.
  • 10. Corte-Real NM, Moreira RM, Guerra-Pinto F. Arthroscopic treatment of tenosynovitis of the flexor hallucis longus tendon. Foot Ankle Int 2012;33:1108-12.
  • 11. Donovan A, Rosenberg ZS. MRI of ankle and lateral hindfoot impingement syndromes. AJR Am J Roentgenol 2010;195:595-604.
  • 12. Nault ML, Kocher MS, Micheli LJ. Os trigonum syndrome. J Am Acad Orthop Surg 2014;22:545-53.
  • 13. Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, Van Dijk CN, et al. Posterior hindfoot arthroscopy: a review. Am J Sports Med 2014;42:225-34.
  • 14. Smyth NA, Murawski CD, Levine DS, Kennedy JG. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. Am J Sports Med 2013;41:1869-76.
  • 15. Barchi EI, Swensen S, Dimant OE, McKay TE, Rose DJ. Flexor hallucis longus tenolysis/tenosynovectomy in dancers. J Foot Ankle Surg 2022;61:84-7.
  • 16. Heier KA, Hanson TW. Posterior ankle impingement syndrome. Oper Tech Sports Med 2017;25:75-81.
  • 17. Michelson JD, Bernknopf JW, Charlson MD, Merena SJ, Stone LM. What is the efficacy of a nonoperative program including a specific stretching protocol for flexor hallucis longus tendonitis? Clin Orthop Relat Res 2021;479:2667-76.
  • 18. Ogut T, Ayhan E, Irgit K, Sarikaya AI. Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 2011;19:1355-61.
  • 19. Georgiannos D, Bisbinas I. Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome in an athletic population: a randomized controlled study with 5-year follow-up. Am J Sports Med 2017;45:1388-94.
  • 20. Qu W, Liu T, Chen W, Sun Z, Dong S, Chen M. Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion. J Orthop Surg (Hong Kong) 2019;27:2309499019863355.
  • 21. Mohanty A, Nayak SS, Samanta SK, Biswas R, Mohanty A. Endoscopic excision of os trigonum in symptomatic ballet dancers of odisha - A prospective cohort study. J Evid Based Med Healthc 2020;7:287-91.
  • 22. Kazuya Sugimoto, Shinji Isomoto, Norihiro Samoto, Tomohiro Matsui, Yasuhito Tanaka. Arthroscopic treatment of posterior ankle ımpingement syndrome: mid-Term clinical results and a learning curve. Arthrosc Sports Med Rehabil 2021;3: e1077-86.
  • 23. Spennacchio P, Cucchi D, Randelli PS, Van Dijk NC. Evidence based indications for hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc 2016;24:1386-95.
  • 24. Morelli F, Mazza D, Serlorenzi P, Guidi M, Camerucci E, Calderaro C, et al. Endoscopic excision of symptomatic os trigonum in professional dancers. J Foot Ankle Surg 2017;56:22-5.
  • 25. Pereira H, Batista J, Sousa D, Gomes S, Pereira JP, Ripoll PL. Posterior impingement and os trigonum. In:Canata G, d’Hooghe P, Hunt K, Kerkhoffs G, Longo U. eds., Sports Injuries of the Foot and Ankle. Springer:Berlin, Heidelberg. 2019: pp.191-206.
  • 26.  Funasaki H, Hayashi H, Sakamoto K, Tsuruga R, Marumo K. Arthroscopic release of flexor hallucis longus tendon sheath in female ballet dancers: dynamic pathology, surgical technique, and return to dancing performance. Arthrosc Tech 2015;4:e769-74.
  • 27. Ögüt T, Yontar NS. Treatment of hindfoot and ankle pathologies with posterior arthroscopic techniques. EFORT Open Rev 2017;2:230-40.
  • 28. Ribbans WJ, Ribbans HA, Cruickshank JA, Wood EV. The management of posterior ankle impingement syndrome in sport: a review. Foot Ankle Surg 2015;21:1-10.
There are 28 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Original Articles
Authors

Murat Saylık 0000-0002-1023-4164

Publication Date January 4, 2023
Submission Date December 1, 2022
Acceptance Date December 14, 2022
Published in Issue Year 2023 Volume: 9 Issue: 1

Cite

AMA Saylık M. Clinical and radiological results of posterior ankle endoscopy treatment for the flexor hallusis longus tenosynovitis and os trigonum syndrome. Eur Res J. January 2023;9(1):155-163. doi:10.18621/eurj.1213036

e-ISSN: 2149-3189 


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