ARTHROSCOPIC TREATMENT OF ANTERIOR ANKLE IMPINGEMENT SYNDROME IN DANCERS

Abstract

A retrospective review of the medical records, radiological studies, operative reports, and physiotherapy charts was done for 11 consecutive elite dancers (7 [64%] women and 4 [36%] men) who underwent arthroscopic treatment for anterior ankle impingement syndrome during a 9-year period (1990–1999). The procedures were performed by a single surgeon (DJR) at one hospital (Hospital for Joint Diseases). There were 14 arthroscopic procedures (12 initial and 2 repeat) involving the right ankle in 8 (57%) and the left ankle in 6 (43%). Average age (± standard deviation) at surgery was 28 ± 6 years (age range, 20–41 years). There were 6 (55%) professional dancers, 4 (36%) pre-professional dance students, and 1 (9%) professional dance teacher; all were primarily ballet dancers, but three concurrently performed modern dance.

In 6 (50%) ankles, soft tissue impingement only (hypertrophic synovitis or impinging distal fascicle of the inferior band of the anterior tibiofibular ligament) was noted, and in 6 (50%) ankles, a bony spur was also present on the anterior lip of the tibia and/or dorsal aspect of the talar neck. Resection of bony spurs and excision of hypertrophic soft tissue and synovium was performed arthroscopically. Nine (82%) of the 11 patients returned to dance after an average period of 7 weeks (range, 6 to 11 weeks). There were no wound infections or neuromas. One ankle with soft tissue impingement developed postoperative stiffness despite physical therapy, and underwent repeat arthroscopy 4 months after the initial procedure for excision of adhesions and scar tissue; this dancer subsequently returned to competitive dance. Another ankle had a second arthroscopic debridement for recurrent spur formation, 9 years after the first arthroscopic excision; this dancer retired from dance performance after the first arthroscopy because of concurrent knee and back problems, but he continued at a lower activity level as a dance teacher. In summary, arthroscopic debridement was effective in the management of anterior ankle impingement in dancers.