Loose bodies and osteophytes

Arthroscopic ankle surgery is successful in other pathologies apart from impingement and OLT.

Martin (72) and Ferkel (73) in 1989 reported 71% good / excellent results for OLT lesion, 57% good / excellent results for loose bodies and osteophytes and 12% good / excellent results for DJD.

With loose bodies, it is necessary to inspect the posterior compartment and you need to check all the articular surfaces carefully after their removal.

Osteophytes in the ankle are a common condition known as the ‘anterior kissing lesion’ or ‘footballer’s ankle’. It was O’Donoghue in 1966 who reported a 45% incidence in American football players (74). There is an even higher incidence of 59.3% in dancers (75). Patients with ‘footballer’s ankle- present with pain, catching and restricted joint motion (dorsiflexion) and swelling (76). Tol J L et al (77) showed 77% good or excellent results with Grade 1 disease with 53% good or excellent results with Grade 2 disease using arthroscopic resection of the spurs. In 2004 they (78), demonstrated that a plain lateral x-ray is insufficient to detect all anterior osteophytes and an oblique x-ray is a useful adjunct. The author’s preference is a 3-D CT. This is backed up by Takao M et al (79) in their 2004 article.

Treatment aims to reproduce the normal 60 degree tibiotalar angle. One
must be careful to avoid neurovascular injury when performing surgery open or closed. Arthroscopically, the borders of the osteophyte are exposed with a 3.5mm soft tissue resector, then the bony spurs themselves are removed with burrs. Per operative lateral X-ray prior to completion can be taken to ensure sufficient bony resection, it has been shown that one obtains better results if the patients have isolated spurs than generalised DJD (80), but overall excellent results are achievable (71, 82).

A classification grades I - IV was described by Scranton (83), (I - III treatable arthroscopically) but even grade IV lesions can be addressed arthroscopically. Interestingly, talofibular bony impingement can also occur (84).

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References
(72) Martin D F, Baker C L, Curl W W et al ‘Operative ankle arthroscopy, long term follow up. Am J Sports Med 1989; 17:16
(73) Ferkel R D, Fischer S P, ‘Progress in ankle arthroscopy’ Clin Orth 1989; 240:210
(74) O’Donoghue D H, ‘Chondral and osteochondral fractures’ J Trauma 1966; 6 469
(75) Stoller S M, ‘A Comparative study of the frequency of anterior impingement exostosis of the ankle in the dancer and non-dancer’ Foot Ankle 1984; 4:201
(76) Hawkins R B, ‘Arthroscopic treatment of sports related anterior osteophytes in the ankle’ Foot Ankle 1988; 9:87
(77) Tol J L, Verheyen C P, van Dijk C N, ‘Arthroscopic treatment of anterior impingement in the ankle’ JBJS 2001; 83:1; 9-13
(78) Tol J L, Verhagen R AW, Krips R, Maas M, Wessel R, Dijkgraaf M G W, van Dijk C N, ‘The anterior ankle impingement syndrome: diagnostic calue of oblique radiographs’ Foot & Ankle International / Am Orth Foot and Ankle Soc (and) Swiss Foot and Ankle Society 2004; 25:2; 63-8
(79) Takao M, Uchio Y, Naito K, Kono T, Oae K, Ochi M ‘Arthroscopic treatment for anterior impingement exotosis of the ankle: application of three-dimensional computed tomography’ Foot & Ankle International / Am Orth Foot and Ankle Soc (and) Swiss Foot and Ankle Society 2004; 25:2; 59-62
(80) Martin D F, Baker C L, Curl W W et al, ‘Operative ankle arthroscopy - long term follow up’ Am J Sports Med 1989; 17:16.
(81) Hawkins R B, ‘Arthroscopic treatment of sports related anterior osteophytes in the ankle’ Foot Ankle 1988; 9:87
(82) Ogilvie-Harris D J, Mahomed N, Demaziere A, ‘Anterior impingement of the ankle treated by athroscopic removal of bony spurs’ JBJS 1993; 75B:437
(83) Scranton P E, McDermott J E, ‘Anterior tibio-talar spurs: a comparison of open versus arthroscopic treatment’ Foot Ankle 1992; 13:125
(84) St Pierre R K, Velazco A, Fleming L L, ‘Impingement exostosis of the talus and fibula secondary to an inversion sprain - a case report’ Foot Ankle 1983; 3:282