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Anterior and Posterior Ankle Impingement by One-Step Arthroscopic Treatment: 10years Follow-up Prospective Study by Standard Anterior and Double Postero-Medial Portals

      Introduction

      Simultaneous anterior and posterior ankle impingement is preferably treated by 2steps surgery. Aiming to avoid postponing further surgery in prone position, authors focused a procedure which addresses posterior ankle disorders through 2postero-medial portals, after anterior arthroscopic step without changing patient's assessment. They present this 10years follow-up prospective study.

      Methods

      In period January 2001-January 2015 78 ankle affected with both side pathology, were submitted to arthroscopic treatment by standard anterior portals and double postero-medial approach, maintaining supine position and addressing simultaneously one-step surgery anteriorly and posteriorly. Reproducing same posterior portals of prone procedure, peroneal approach is rotated 90°medially lying 5cm superiorly to medial one along Achilles' tendon. FHL tendon landmark prevents damage to posterior tibial bundle. Patients were evaluated with pre-op and post-op x-ray scan and AOFAS scale.

      Results

      At final survey 71patients have been evaluated, being 7 lost. Wilcoxon test was utilized to compare score values reported at admission time, after 12months and after 10years. AOFAS scale, steady improved from preoperative mean 38.73(range21-51) to 1year postoperative=89.87 and to further 95.4 at 10years. The preop vs/postop 12months was p-value=0.00051 and postop 12months vs/10years p-value was =0.03628. Big improvement was reported in study group at 10years follow-up compared to control group (the former p-value=0.0004883, the lesser p-value=0.0009766, inferior to threshold p=0.05). None patient reported any complication, any problem to posterior tibial nerve territory or to medial talus skin sensitivity. Varicose veins caused in 3patients posterior ankle swelling and oedema for 3weeks. Four patients have been submitted to new surgical procedure for same disorder.

      Conclusion

      In open surgery as in arthroscopic procedure, supine assessment made impossible to reach both the joint spaces without intra-operative patient's repositioning. Maintaining supine assessment during arthroscopy, this technique allowed to reach disorders in posterior ankle compartment after anterior treatment by standard portals. Absence of neurovascular lesions confirmed safety and reproducibility of this procedure providing anatomical landmarks respect.