Arthroscopic management of pediatric ankle impingement showed ‘excellent outcomes’

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Kushare I, et al. Paper 31. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).

Disclosures:
Kushare reports no relevant financial disclosures.

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Pediatric patients who underwent arthroscopic management of posterior ankle impingement were able to return to their previous level of activity with minimal complications, according to a pediatric sports medicine specialist.

“Posterior ankle impingement (PAI) syndrome is due to pinching of structures in the ankle in the hindfoot region between the tibia and the calcaneus – the nutcracker effect,” Indranil “Neel” Kushare, MD, said in his presentation at the Pediatric Orthopaedic Society of North America Annual Meeting. “Classically described in hyper plantar flexion activities, like ballet dancers and soccer players, the usual culprits can be either bony or soft tissue,” he added.

Kushare and colleagues from Texas Children’s Hospital prospectively studied 52 patients (66 ankles, mean age of 13.3 years) who were diagnosed with PAI and underwent prone, posterior ankle arthroscopy. Most injuries were sustained in football and soccer. Failure of 44 weeks of conservative management to relieve symptoms or recurrence of symptoms after return to activity was cause for indication to surgery.

Indranil “Neel” Kushare

According to Kushare, 53% of impingement pathology was predominantly bony, while 47% was predominantly soft tissue.

All 52 patients returned to their previous level of activity or sport at an average of 8.3 weeks, Kushare and colleagues found. Additionally, the researchers found a statistically significant improvement in VAS scores from 7 to 0.56 and American Orthopaedic Foot & Ankle Society scores from 63.5 preoperatively to 95.6 postoperatively. One patient experienced persistent numbness over lateral part of the heel, which was the only complication reported among the cohort.

Overall, Kushare and colleagues found arthroscopic management of PAI showed “excellent outcomes” in a pediatric population after failed conservative management.

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