Endoscopic treatment of the posterior ankle impingement syndrome on amateur and professional athletes

Orientador: Maurício EtchebehereTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução Uma das principais causas de dor na região posterior do tornozelo é a síndrome do impacto posterior do tornozelo (SIPT). Ela consiste de sintomas dolorosos na região posterolateral ou posteromedial do tornozelo, associados a flexão plantar forçada. Atinge principalmente bailarinos e atletas. O diagnóstico pode ser realizado através das radiografias convencionais ou incidências especiais, tomografia computadorizada (TC) e ressonância nuclear magnética (RNM). O tratamento inicial é conservador, sendo que na sua falha, procedimentos cirúrgicos são indicados. Classicamente as vias de acesso abertas são utilizadas. Recentemente, os tratamentos artroscópicos ou endoscópicos têm se popularizado, tendo a suposta vantagem de proporcionar resultados e reabilitação melhores. Os atletas são uma população com grande exigência e demanda física, estando entre os mais favorecidos por esses métodos. Objetivo Determinar se atletas amadores e profissionais apresentam diferença na função do tornozelo e no tempo de retorno ao esporte, após cirurgia endoscópica para tratamento da SIPT. Avaliar o tempo de duração do procedimento, os achados intraoperatórios, a presença de complicações e o grau de satisfação com o procedimento. Verificar se a presença de outras lesões associadas influenciam na evolução clínica desses pacientes. Métodos Trinta e dois atletas com diagnóstico de SIPT foram submetidos ao tratamento cirúrgico por via endoscópica. Realizou-se a comparação dos resultados entre atletas amadores (15) e profissionais (17) através da análise da escala da American Orthopaedic Foot and Ankle Society (AOFAS). O tempo de retorno ao esporte, o tempo do procedimento, os achados intraoperatórios, as complicações e o grau de satisfação foram avaliados, bem como se a presença de lesões associadas influenciaria nesses resultados. Resultados A pontuação da escala AOFAS pré-operatória foi de 67,9 +/- 19,7 e pós-operatória de 94 +/- 9,3 nos amadores e 62,9 +/- 14 e 92,3 +/- 7,7 nos profissionais. O tempo de retorno ao esporte foi similar (p = 0,88) em ambos os grupos, com média de 16,3 ± 9 semanas nos amadores e 15,6 ± 13,7 nos profissionais. O tempo médio de procedimento foi de 48,3 +/- 25 minutos, com tendência de queda. O acometimento ósseo foi encontrado em 100% dos casos. Três complicações foram observadas. O grau de satisfação foi considerado excelente e ótimo em 94% dos casos e regular em 6%. As lesões associadas mais comuns foram o impacto anterior (73,3%) e a instabilidade crônica do tornozelo (40%). Conclusões Não houve diferença significativa nos resultados funcionais e no tempo de retorno ao esporte entre os grupos de atletas amadores e profissionais. O tempo de duração do procedimento diminuiu à medida que a experiência da equipe cirúrgica aumentou. As alterações ósseas foram os achados intraoperatórios mais encontrados. Houve baixa taxa de complicações e alto grau de satisfação com o tratamento. As lesões associadas não influenciaram os resultadosAbstract: Background One of the main causes of pain in the posterior ankle is the impingement syndrome (PAIS). It consists of forced plantar flexion associated with painful symptoms in the posterolateral or posteromedial region of the ankle. Primarily it affects dancers and athletes. Diagnosis may be done by conventional radiographs or special views, computed tomography (CT) and/or magnetic resonance imaging (MRI). Initially, conservative treatment should be recommended, and when there is no success, the surgical treatment should be considered. Conventional open surgical treatment is usually done. Recently, a new therapeutic approach was described, consisting of endoscopy or arthroscopy of the hindfoot. The advantages should be better results and rehabilitation. The athletes are the group who has these need and demand, being the most favoured by these methods. Purposes To determine whether professional and amateur athletes showed differences in ankle function when treated with an endoscopic technique for PAIS and to assess time to return to sport. To evaluate operative time, intraoperative findings, complications and satisfaction rates. To verify the impact of the presence of associated lesions in clinical evolution. Methods Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The time to return to sport, operative time, intraoperative findings, complications and satisfaction rates were evaluated, and the presence of associated injuries interfering with these results was verified. Results The preoperative AOFAS score range for the amateur group was 67.9 ± 19.7 preoperatively and 94 ± 9.3 postoperatively and for the professional group was 62.9 ± 14 and 92.3 ± 7.7, respectively. Time to return to sports was similar (p = 0,88) in both groups, and the mean time was 16.3 ± 9 weeks for amateurs and 15.6 ± 13.7 for professionals. The average time of surgery was 48.3 +/- 25 min. Bone involvement was present in 100% of cases and complications in three cases. The satisfaction was excellent or good in 94% of all cases and fair in 6%. Anterior impingement (73.3%) and ankle chronic instability (40%) were the most common associated injuries. Conclusions No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Operative time decreased while team experience increased. Bone lesions were the most founded ones. Athletes showed low complication rate and mainly good and excellent results. The presence of associated injuries did not significantly influence the resultsDoutoradoFisiopatologia CirúrgicaDoutor em Ciência

Reliability Of Two Smartphone Applications For Radiographic Measurements Of Hallux Valgus Angles

The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.56223023

Peroneal Tenodesis With the Use of Tendoscopy: Surgical Technique and Report of 1 Case

Peroneus brevis tendon injury is the most common lesion of the peroneal tendons. The initial treatment is conservative, and surgical treatment is indicated if conservative treatment fails. It is often necessary to open the entire upper and lower retinaculum to obtain adequate visualization of the structures. We present a case in which the peroneus brevis tenodesis was used with the aid of tendoscopy. This technique should be used for patients with lesions affecting more than 50% of the tendon diameter. We found that, by making small incisions, the patient recovered well, quickly, with resolution of pain

Endoscopic Treatment Of The Posterior Ankle Impingement Syndrome On Amateur And Professional Athletes

To determine whether professional and amateur athletes showed differences in ankle function when treated with endoscopic technique for posterior ankle impingement syndrome, to verify the impact of the presence of associated lesions in clinical evolution and to assess time to return to sport (we hypothesize that time will be the only difference between groups). Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedics Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The satisfaction, time to return to sport, operative time, intraoperative findings and complications were evaluated, and the presence of associated injuries interfering in these results was verified. The preoperative AOFAS score range for the professional group was 62.9 +/- A 14 preoperatively and 92.3 +/- A 7.7 postoperatively, and for the amateur group was 67.9 +/- A 19.7 and 94 +/- A 9.3. The satisfaction was excellent or good in 94 % of all cases and fair in 6 %. The average time of surgery was 48.3 + 25 min. Bone involvement was present in 100 % of cases and complications in three cases. Time to return to sports was similar (n.s.) in both groups, and the mean time was 15.6 +/- A 13.7 and 16.3 +/- A 9 weeks, respectively. No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Athletes showed mainly good and excellent results and low complication rate. The presence of associated injuries did not significantly influence the results. With these results, the high-level athlete can better programme their surgeries so they can fully recover and perform better in the most important competitions. Level III.2441396140

Reliability of two smartphone applications for radiographic measurements of hallux valgus angles

The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus562230233sem informaçã

Endoscopic treatment of the posterior ankle impingement syndrome on amateur and professional athletes

To determine whether professional and amateur athletes showed differences in ankle function when treated with endoscopic technique for posterior ankle impingement syndrome, to verify the impact of the presence of associated lesions in clinical evolution and to assess time to return to sport (we hypothesize that time will be the only difference between groups). Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedics Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The satisfaction, time to return to sport, operative time, intraoperative findings and complications were evaluated, and the presence of associated injuries interfering in these results was verified. The preoperative AOFAS score range for the professional group was 62.9 +/- A 14 preoperatively and 92.3 +/- A 7.7 postoperatively, and for the amateur group was 67.9 +/- A 19.7 and 94 +/- A 9.3. The satisfaction was excellent or good in 94 % of all cases and fair in 6 %. The average time of surgery was 48.3 + 25 min. Bone involvement was present in 100 % of cases and complications in three cases. Time to return to sports was similar (n.s.) in both groups, and the mean time was 15.6 +/- A 13.7 and 16.3 +/- A 9 weeks, respectively. No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Athletes showed mainly good and excellent results and low complication rate. The presence of associated injuries did not significantly influence the results. With these results, the high-level athlete can better programme their surgeries so they can fully recover and perform better in the most important competitions. Level III2441396140

Endoscopic Treatment Of The Posterior Ankle Impingement Syndrome On Amateur And Professional Athletes.

To determine whether professional and amateur athletes showed differences in ankle function when treated with endoscopic technique for posterior ankle impingement syndrome, to verify the impact of the presence of associated lesions in clinical evolution and to assess time to return to sport (we hypothesize that time will be the only difference between groups). Thirty-two athletes with a diagnosis of posterior impingement syndrome underwent surgery endoscopically. The American Orthopaedics Foot and Ankle Society (AOFAS) scale was used to compare functional results between amateur (15) and professional athletes (17). The satisfaction, time to return to sport, operative time, intraoperative findings and complications were evaluated, and the presence of associated injuries interfering in these results was verified. The preoperative AOFAS score range for the professional group was 62.9 ± 14 preoperatively and 92.3 ± 7.7 postoperatively, and for the amateur group was 67.9 ± 19.7 and 94 ± 9.3. The satisfaction was excellent or good in 94 % of all cases and fair in 6 %. The average time of surgery was 48.3 + 25 min. Bone involvement was present in 100 % of cases and complications in three cases. Time to return to sports was similar (n.s.) in both groups, and the mean time was 15.6 ± 13.7 and 16.3 ± 9 weeks, respectively.  CONCLUSION: No significant difference regarding functional results and time to return to sports between professionals and amateur athletes operated was found. Athletes showed mainly good and excellent results and low complication rate. The presence of associated injuries did not significantly influence the results. With these results, the high-level athlete can better programme their surgeries so they can fully recover and perform better in the most important competitions. Level III.2