ARTHROSCOPY IN ANTERIOR CAPSULAR ENTRAPMENT SYNDROME OF THE ANKLE: A RETROSPECTIVE STUDY OF 59 CASES

Abstract

Introduction and Objectives: Approximately 30–50% of injuries to the ankle involve soft tissues.

Materials and Methods: Fifty-nine patients diagnosed with anterior capsular entrapment syndrome (ACES) of the ankle were treated using arthroscopic debridement from May 1993 to October 2002. All patients presented with chronic pain and limitation of dorsiflexion after more than 4–6 months of conservative treatment. The study included 34 males and 25 females with an average age of 25 years. The principal cause ACES was one or more forced supinations of the ankle. More than half of the patients participated regularly in sports activities. The study did not include patients with a previous history of ankle surgery, fractures, frank instability, arthrosis, significant cartilaginous lesions (osteochrondritis, osteonecrosis, etc.), arthrofibrosis, or systemic arthritis, patients older than 60 years, and those with less than 6 months of follow-up time. Diagnosis of ACES was generally based on clinical data. The most commonly-used supplemental modalities were ultrasound and MRI. Patients were evaluated using the Ogilvie-Harris scale. Changes in variable values were evaluated using the Wilcoxon test, and the threshold for statistical significance was set at p< 0.05.

Results: Patients experienced significant improvements both subjectively (100% would have the same intervention again even though in 2 cases results were only fair) and based on the Ogilvie-Harris scale. Pain and functional limitation showed the greatest improvement, as compared to inflammation, stiffness, or instability. In all cases, differences in pre- and postoperative values were statistically significant (p< 0.05). During arthroscopic surgery, anterior synovial thickening was noted in all cases (lateral, medial and/or central) associated in some cases with osteophytosis and tibiotalar chondromalacia. The main complications were paresthesia and dysesthesia. Average follow-up time was 43 months (6 months – 9 years).

Discussion and Conclusions: It may be concluded from our study that in a high percentage of cases of ACES of the ankle without degenerative changes or significant instability, good results are achieved with arthroscopic surgery.