Ankle impingement syndrome
Depending on the site of injury, ankle impingement syndrome can be divided into.
1. Anterolateral impingement syndrome: Posterior ankle rotation injuries usually result in tears of the anterior talofibular ligament, heel-fibular ligament and anterolateral joint capsule. Because the inflammatory tissue resembles the meniscus of the knee under the arthroscope, it is also known as a “meniscus-like injury”.
2. Medial impingement syndrome: Injury to the external or internal ankle joint can lead to tearing or compression of the deltoid ligament, local scarring or hypertrophy of synovial tissue, which can cause pain when the ankle is embedded between the posterior edge of the medial ankle and the medial wall of the talus during plantarflexion and internal rotation.
3, anterior impingement syndrome: usually bony impingement, most commonly caused by the anterior border of the talar neck or distal tibial joint, sometimes the free body of synovial chondromatosis accumulates in the anterior part of the joint capsule, which can also lead to anterior impingement syndrome.
4. Posterior impingement syndrome: Bony impingement is common, such as injury to the talar triangle and overgrowth of the posterior process of the talus or heel bone. Ectopic muscles, such as the 4th peroneal muscle, heel peroneal intrinsic muscle and other soft tissues can also cause posterior impingement syndrome.
Diagnosis and differential diagnosis
1. Symptoms Usually the patient has a history of ankle sprain and pain at the injury site, which can be caused by a specific movement and can be accompanied by a feeling of “hitting softness”. The symptoms are aggravated after exercise and can be partially relieved after rest.
2. Physical signs
(1) pressure pain: pressure pain in the joint space, and the injury site corresponds to. For example, the pressure pain of anterolateral impingement syndrome is in the anterolateral joint space.
(2) Compression pain: Pain can be induced by passive plantar flexion/dorsal extension of the ankle joint combined with inversion/external rotation. For example, in anterolateral impingement syndrome, pain at the anterolateral joint space occurs during dorsiflexion and valgus of the ankle, a typical sign of anterolateral impingement syndrome. Posterior pain during passive plantarflexion is a sign of posterior impingement syndrome.
3. Auxiliary examinations include ankle x-ray and MRI.
(1) X-ray: used to diagnose bony impingement syndrome.
(2) MRI: It can show the site and cause of impingement. For example, anterolateral impingement syndrome usually shows the low-signal scar tissue causing the impingement clearly in T2WI images against the high-signal contrast of the surrounding joint fluid.
Treatment
Conservative treatment includes rest, oral NSAIDs, physical therapy, local closure therapy and ankle rehabilitation training.
2.Surgical treatment
(1) Arthroscopic surgery: The main treatment is arthroscopy to remove the synovial membrane and soft tissue masses that cause impingement. Arthroscopic surgery is effective for simple ankle joint soft tissue impingement syndrome. Impingement syndromes caused by hyperplastic bone masses can also be treated arthroscopically with osteotomy. Arthroscopic surgery allows complete removal of the osteochondral bulge through 2-3 small incisions of about 4 mm, while managing concurrent injuries such as synovitis, free bodies, and cartilage damage, with good surgical efficacy, minimal trauma, and rapid recovery. In our cases, the excellent rate of arthroscopic treatment of anterior bony impingement can reach more than 98%.
The anterior ankle impingement was visible on the preoperative X-ray.
Removal of the free body
Microscopic grinding of the tibial tuberosity
Clearing the hyperplastic adhesions
(2) Larger bony impingements and some rare impingement syndromes caused by ectopic muscles should be treated with an incision.
(3) In cases of combined chronic instability of the ankle joint, reconstruction of the ligaments during surgery is required to restore the stability of the joint.