Athletes frequently present with symptomatic os trigonum, and usually a non-operative treatment is chosen first. However, non-operative treatment requires an extended recovery period, and the results may be unsatisfactory. We arthroscopically treated 12 cases of symptomatic os trigonum in 12 athletes and examined the postoperative results.
We treated the os trigonum arthroscopically in nine men and three women; the average age was 21.4 years. All patients were injured during a sports activity. The operation was performed using posterolateral and accessory posterolateral portals. Once the entire flexor hallucis longus tendon was seen, the operation was complete. No splints or casts were applied postoperatively. The stitches were removed 1 week after surgery, and the athletes gradually returned to sports activity from 3 week after surgery.
The average postoperative AOFAS ankle-hindfoot score improved from 68.0 to 98.3 points. The average period of a return to sports was 5.9 weeks (range, 3-13 weeks).
Non-operative treatment should be the first choice for cases of symptomatic os trigonum. However, non-operative treatment may produce unsatisfactory results in some cases. In particular, an extended sports restriction for competitive athletes results in poor fitness levels. Arthroscopic treatment has a rather high cost and risks; it leaves a 2 cm scar, takes two hours of operation time, and up to 2 months of recovery.
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