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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-06-2013 | Ankle

Arthroscopy combined with hardware removal for chronic pain after ankle fracture

Authors: Hyong-Nyun Kim, Yoo-Jung Park, Gab-Lae Kim, Yong-Wook Park

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2013

Abstract

Purpose

The purpose of this study was to evaluate the effectiveness of arthroscopy combined with hardware removal for chronic pain after satisfactory healing of an ankle fracture. We hypothesized that combining hardware removal with arthroscopy for the intra-articular pathology would improve residual complaints more so than hardware removal alone.

Methods

The outcomes of the 53 young male patients with chronic pain after healed ankle fracture treated with two different therapeutic plans: (1) conservative treatment after hardware removal (group A) and (2) arthroscopic intervention with hardware removal (group B) were prospectively studied. Patients were reviewed preoperatively and 6 and 12 months postoperatively using American Foot and Ankle Society (AOFAS) scale.

Results

Median AOFAS scores improved from 74 (66–80) points to 76 (73–92) points in group A and from 75 (64–80) points to 85 (72–100) points in group B, and this improvement was significantly higher for patients in group B (p = 0.001).

Conclusions

This study supports the notion that when there is a definite diagnosis such as loose body, bony impingement, or anterolateral soft-tissue impingement causing chronic pain after healed ankle fracture, arthroscopic treatment with hardware removal is a better treatment option than hardware removal and conservative treatment.

Level of evidence

Prospective comparative study, Level II.

Baums MH, Kahl E, Schultz W, Klinger HM (2006) Clinical outcome of the arthroscopic management of sports-related “anterior ankle pain”: a prospective study. Knee Surg Sports Traumatol Arthrosc 14:482–486PubMedCrossRef

Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK, Soucacos PN (1997) Surgical treatment of malleolar fractures. a review of 144 patients. Clin Orthop Relat Res 341:90–98PubMedCrossRef

Brown OL, Dirschl DR, Obremskey WT (2001) Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 15:271–274PubMedCrossRef

Buckwalter JA (1998) Articular cartilage: injuries and potential for healing. J Orthop Sports Phys Ther 28:192–202PubMed

Busam ML, Esther RJ, Obremskey WT (2006) Hardware removal: indications and expectations. J Am Acad Orthop Surg 14:113–120PubMed

Day GA, Swanson CE, Hulcombe BG (2001) Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int 22:102–106PubMed

Dell’accio F, Vincent TL (2010) Joint surface defects: clinical course and cellular response in spontaneous and experimental lesions. Eur Cell Mater 20:210–217PubMed

Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ (2006) Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am 88:974–979PubMedCrossRef

French HG, Cook SD, Haddad RJ Jr (1984) Correlation of tissue reaction to corrosion in osteosynthetic devices. J Biomed Mater Res 18:817–828PubMedCrossRef

10.

Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP (2009) Evidence-based indications for ankle arthroscopy. Arthroscopy 25:1478–1490PubMedCrossRef

11.

Jackson DW, Lalor PA, Aberman HM, Simon TM (2001) Spontaneous repair of full-thickness defects of articular cartilage in a goat model. A preliminary study. J Bone Joint Surg Am 83:53–64PubMedCrossRef

12.

Jacobsen S, Honnens de Lichtenberg M, Jensen CM, Torholm C (1994) Removal of internal fixation—the effect on patients’ complaints: a study of 66 cases of removal of internal fixation after malleolar fractures. Foot Ankle Int 15:170–171PubMedCrossRef

13.

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMedCrossRef

14.

Lee MJ, Kim S, Lee SA et al (2007) Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics 27:791–803PubMedCrossRef

15.

Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91:333–339PubMedCrossRef

16.

Loren GJ, Ferkel RD (2002) Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy 18:412–421PubMedCrossRef

17.

Richards RH, Palmer JD, Clarke NM (1992) Observations on removal of metal implants. Injury 23:25–28PubMedCrossRef

18.

Stradiotti P, Curti A, Castellazzi G, Zerbi A (2009) Metal-related artifacts in instrumented spine. Techniques for reducing artifacts in CT and MRI: state of the art. Eur Spine J 18(Suppl 1):102–108PubMedCrossRef

19.

Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B (2010) Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am 92:279–286PubMedCrossRef

20.

Takao M, Uchio Y, Naito K, Fukazawa I, Kakimaru T, Ochi M (2004) Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures. J Trauma 57:1303–1307PubMedCrossRef

21.

Thomas B, Yeo JM, Slater GL (2005) Chronic pain after ankle fracture: an arthroscopic assessment case series. Foot Ankle Int 26:1012–1016PubMed

22.

Utsugi K, Sakai H, Hiraoka H, Yashiki M, Mogi H (2007) Intra-articular fibrous tissue formation following ankle fracture: the significance of arthroscopic debridement of fibrous tissue. Arthroscopy 23:89–93PubMedCrossRef

23.

van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for problems after ankle fracture. J Bone Joint Surg Br 79:280–284PubMedCrossRef

24.

Zengerink M, van Dijk CM (2012) Complication in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 20:1420–1431PubMedCrossRef

25.

Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systemic review. Knee Surg Sports Traumatol Arthrosc 18:238–246PubMedCrossRef

Title: Arthroscopy combined with hardware removal for chronic pain after ankle fracture
Authors: Hyong-Nyun Kim
Yoo-Jung Park
Gab-Lae Kim
Yong-Wook Park
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2298-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arthroscopy combined with hardware removal for chronic pain after ankle fracture

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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