Anterior impingement

 

Definition

 

Impingement between anterior distal tibial osteophyte and sulcus of the talus in dorsiflexion

 

Epidemiology

 

Seen in athletes with repetitive dorsiflexion

Football / soccer / ballet / gymnasts

 

Pathology

 

Anterior osteophytes

Soft tissue impingement - scar tissue in anterolateral gutter from recurrent ankle sprains

Bassett's ligament - thickened fascicle of the AITFL

 

Xray

 

Ant impingementAnkle Xray Anterior Tibial Osteophyteanterior impingement

Anterior tibial and talus spurs with normal joint space

 

CT

 

ant impingementAnkle CT

Anterior tibial and talus spurs with normal joint space

 

MRI

 

AI MRIAI MRI

 

AI MRIAI MRI

 

Operative Management

 

Arthroscopic debridement

 

Indications

 

Painful and limited ankle dorsiflexion

Anterior osteophytes

Preserved tibiotalar cartilage

 

Technique

 

Vumedi anterior bony impingement video

 

Vumedi anterior bony impingement video

 

Ankle Scope Anterior Tibial OsteophyteAnkle Scope Osteophyte Debridement

 

Results

 

Gianakos et al AJSM 2021

- systematic review of 28 articles and 1500 patients

- arthroscopic debridement of anterolateral and anteromedial impingement

- success rate 80%

- complication rate 4% (mild nerve injury, superficial infection)

 

van Dijk et al AJSM 1997

- 67 patients with 2 year follow up

- no joint space narrowing: 90% good results

- joint space narrowing: 50% good results