• Anatomic research
• Clinical efficacy
• Impingement syndrome
• Operative approach
• Posterior ankle
• Safety

• Stieda
• associated
• combined
• endoscopy
• hindfoot
• os trigonum
• posterior ankle impingement
• trigonal

• Haglund’s retrocalcaneal bursitis
• Posterior ankle arthroscopy
• flexor hallucis longus impingement
• foot and ankle
• hindfoot arthroscopy
• os trigonum
• posterior osteochondral lesions of the talus
• posterior talar body fractures
• prone arthroscopy
• subtalar arthroscopy

• Humans
• Ankle/surgery
• Arthroscopy
• Ankle Joint/surgery
• Foot
• Lower Extremity

• accessory portal
• complications
• endoscopy
• neural
• neurologic
• posterior ankle arthroscopy
• posterior hindfoot arthroscopy
• posterior subtalar arthroscopy
• prone

• ballet
• foot and ankle injury
• injury epidemiology
• sports medicine

• Ballet
• Dance
• Impingement
• Sesamoiditis
• Stress fracture

A talar body fracture is relatively rare. Surgical treatment for the fracture is generally indicated for the displaced fracture types and traditionally performed via open approaches. However, open approaches may not be able to achieve adequate exposure of the talus body owing to the difficulty in achieving reduction and fixation of the fracture. In this case report, we describe a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. Case report. A 39-year-old man who was a carpenter complained of right hindfoot pain after he fell from a stepladder during work. Although plain radiographs of the right ankle showed no abnormal findings, noncontrast computed tomography demonstrated a fracture line from the lateral side of the posterior lateral process to the medial side of the talus body. In addition, the fracture line extended to the posterior ankle and subtalar joints, and the bone fragment was slightly displaced. We diagnosed him with the talar body fracture and performed operative treatments using hindfoot endoscopic reduction and internal fixation. At 14 weeks after the operation, he was able to return to work at the preinjury activity level without dysfunction of the ankle nor complications.

We reported a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. In this case, the hindfoot endoscopic technique provided visualization of the fracture site with less invasiveness and increased safety, which enabled proper reduction and internal fixation of the fracture site. Therefore, the patient was able to return to work at the preinjury activity level at 14 weeks after surgery without dysfunction of the ankle nor complications. This surgical technique may be a useful option for the talar body fracture.

• ankle
• arthroscopy
• os trigonum
• posterior impingement

To report mid-term clinical results of posterior ankle arthroscopy in the treatment of posterior ankle impingement syndrome (PAIS) and to assess the learning curve and its influence on the results.

This was a retrospective evaluation of the clinical outcomes of posterior ankle arthroscopy and its learning curve in a series of patients with PAIS. Demographic and clinical data, surgical time, the American Orthopaedic Foot Ankle Society (AOFAS) ankle/hindfoot scores, and time to resumption of sports were recorded.

Fifty-nine patients with 72 posterior ankle arthroscopies were evaluated at a mean follow-up period of 60 months (24-133 months). Causes of PAIS were an os trigonum (50), a large posterior talar process (14), and soft-tissue impingement (8). There were 29 male and 30 female patients. The average age was 21.8 years (12-74 years). The average preoperative AOFAS score improved significantly from 79.6 to 97.6 postoperatively (P < .0001). The average time taken to resume training was 5.3 weeks, and the time to return to a competitive condition was 13.4 weeks. The times to resumption of training were shorter in elite athletes than local competitive athletes. The learning curve of the posterior ankle arthroscopy was detected and determined by a logarithmic trendline and moving averages. An experience of 26 cases was required to be proficient in posterior arthroscopies. The postoperative AOFAS scores were not statistically different between the initial and the latest 10 series each.

The mid-term follow-up results of endoscopic treatment for the PAIS were good, with a high success rate in returning to sports activities. Although a learning curve effect was detected in our series of arthroscopic treatment for the PAIS due to os trigonum, a low volume of experience did not affect the results.

Level IV, therapeutic case series.

• Ankle arthroscopy
• Ankle pain
• Os trigonum
• Pediatric ankle
• Posterior ankle impingement

• Dancing injuries
• Flexor hallucis longus
• Os trigonum
• Posterior ankle endoscopy
• Posterior ankle impingement

• Ankle Injuries/diagnosis
• Ankle Injuries/etiology
• Ankle Injuries/physiopathology
• Ankle Injuries/therapy
• Ankle Joint/anatomy & histology
• Ankle Joint/physiopathology
• Ankle Joint/surgery
• Athletic Injuries/diagnosis
• Athletic Injuries/etiology
• Athletic Injuries/pathology
• Athletic Injuries/therapy
• Hallux/anatomy & histology
• Hallux/physiopathology
• Humans
• Muscle, Skeletal/anatomy & histology
• Muscle, Skeletal/injuries
• Muscle, Skeletal/pathology
• Muscle, Skeletal/physiopathology
• Musculoskeletal Pain/etiology
• Musculoskeletal Pain/therapy
• Orthopedic Procedures/methods
• Syndrome
• Treatment Outcome

• dancers
• foot and ankle injury
• os trigonum
• posterior ankle impingement
• sports

• Ankle
• Children
• Impingement
• Magnetic resonance imaging
• Os trigonum
• Posterior ankle impingement
• Stieda process

Posterior ankle impingement syndrome (PAIS) is a cause of ankle pain due to pinching of bony or soft tissue structures in the hindfoot. The diagnosis is primarily made based on detailed history and accurate clinical examination. The delay in its diagnosis has not yet been described in the pediatric and adolescent population.

To identify and characterize misdiagnosed cases of PAIS in pediatric and adolescent patients.

This descriptive prospective study at a tertiary children’s hospital included patients ≤ 18 years who underwent posterior ankle arthroscopy after presenting with chronic posterior ankle pain after being diagnosed with PAIS. Collected data included: Demographics, prior diagnoses and treatments, providers seen, time to diagnosis from presentation, and prior imaging obtained. Visual Analogue Scale (VAS) for pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted at initial presentation and follow-up.

35 patients (46 ankles) with average age of 13 years had an average 19 mo (range 0-60 mo) delay in diagnosis from initial presentation. 25 (71%) patients had previously seen multiple medical providers and were given multiple other diagnoses. All 46 (100%) ankles had tenderness to palpation over the posterior ankle joint. Radiographs were reported normal in 31/42 (72%) exams. In 32 ankles who underwent MRI, the most common findings included os trigonum (47%)/Stieda process (47%). Conservative treatment had already been attempted in all patients. Ankle impingement pathology was confirmed during arthroscopy in 46 (100%) ankles. At an average follow-up of 13.1 mo, there was an improvement of VAS (pre-op 7.0 to post-op 1.2) and AOFAS scores (pre-op 65.1 to post-op 94).

This is the first study which shows that PAIS is a clinically misdiagnosed cause of posterior ankle pain in pediatric and adolescent population; an increased awareness about this diagnosis is needed amongst providers treating young patients.

• Ankle impingement
• Ankle pain
• Os trigonum
• Delayed diagnosis
• Ankle arthroscopy
• Pediatric

• Ankle
• Athletic injuries
• Entrapment
• Impingement
• MR imaging

Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.

• Posterior ankle impingement syndrome
• Arthroscopy
• Endoscopy
• Review
• Os trigonum