Clinical outcome of the arthroscopic management of sports-related "anterior ankle pain": a prospective study

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. We reviewed 26 (16 male and 10 female) athletes with a mean age of 27 years treated arthroscopically for symptoms due to soft-tissue (group I, n = 12) and bony obstruction (group II, n = 14). They suffered from anterior pain, reduction of dorsiflexion and recurrent swelling with severe impairment in their sports activities. There was no clinical improvement for at least 6 months despite of conservative treatment with a mean duration of symptoms about 20 months. There were no further operations. Evaluation included the Karlsson ankle rating score, the activity score of Tegner, and a visual analogue scale (VAS) reflecting patients' pain. Conventional radiographs and Magnetic resonance imaging (MRI) were done preoperatively. All patients were available for follow up after 31 months (range, 25-48 months) with a significant improvement (p < 0.05) of the Karlsson score from 66 to a mean of 92 at the follow-up examination. The mean Tegner score was eight points compared to three points preoperatively. Regarding the subjective assessment observed by the decrease of pain and the ability of the athelete to return to competition sport, there were 25 very satisfied and one unsatisfied athlete. No significant difference in the outcome of group I and II (p > 0.05) could be estimated. The results demonstrate 'excellent' to 'good' results for arthroscopic treatment of sports-related anterior ankle pain in a group of athletes who were involved in competition sport. The promising clinical results confirm an effective way of treating soft-tissue and bony impingement. In addition, we recommend prior to surgery, an adequate course of non-operative treatment, including modifications in the exercise program and athletic activity.