Surgical Management of Complex Ankle Bony Impingement Combined With Chronic Ankle Instability

Anterior ankle bony impingement, which can cause pain and dysfunction of the ankle, is commonly seen in sports injuries. Its primary cause is repeated injury due to chronic ankle instability. An excellent clinical result has been reported by surgically removing osteophytes and ankle stabilization. However, reports of complex anterior impingement combined with lateral ankle instability are rare, which remains challenging in clinical practice.

The purpose of this study was to evaluate the clinical outcomes of anterior ankle bony impingement combined with lateral ankle instability with surgical dissection of osteophytes and stabilization. It was hypothesized that complex ankle osteophytes with instability would achieve optimal clinical outcomes through surgical management.

Case series; Level of evidence, 4.

A total of 57 patients with complex ankle bony impingement combined with lateral instability treated with surgical dissection of complex osteophytes between September 2013 and January 2019 were enrolled in the study. The clinical outcomes were evaluated by visual analog scale (VAS) for pain score, American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and radiographic examination with a mean follow-up time of 39.6 months. Postoperative ankle function and complications were compared using the t test and post hoc Tukey significant difference test.

The mean AOFAS score significantly increased at the 3-month, 1-year, and 2-year follow-ups compared with the preoperative condition (t = 10.57, P = .0001). The mean Karlsson score after surgery also significantly improved at each follow-up time compared with the preoperative score (t = 12.93, P = .0001). The preoperative VAS score significantly decreased at 3 months, 1 year, and 2 years postoperatively (t = 8.73, P = .001). A significant improvement of mean dorsiflexion difference was observed at 3 months and 1 year compared with the preoperative condition, but it seemed to have regressed at the 2-year follow-up (t = 2.11, P = .01). Tibial side recurrence was found in 9 cases, including 7 Scranton type 1 and 2 Scranton type 2. Talar side recurrence was also found in 3 of those cases.

Our retrospective study demonstrated that complex ankle bony impingement combined with lateral instability can yield good clinical results when treated surgically with both ankle stabilization and osteophyte removal.