Anterior and posterior ankle impingement.
Anterior and posterior ankle impingement.
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DOI：
10.1016/j.fcl.2006.06.003
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发表时间：
2006-09-01
影响因子：
1.5
通讯作者：
Niek van Dijk, C
中科院分区：
文献类型：
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作者：
Niek van Dijk, C
前踝撞击的特征是活动时前踝疼痛。经常性（过度）背屈是原因。通常，触诊前内侧或前外侧关节线时会出现疼痛。有些肿胀或背屈受限。平片可以显示撞击的原因。在骨刺或骨赘的情况下，诊断是前骨撞击。在没有骨刺或骨赘的情况下，诊断为前部软组织撞击。前内侧撞击征的患者，平片常呈假阴性。在这些患者中，建议使用斜位视图（前内侧撞击视图= AMI视图）。关节镜下治疗并切除病变组织可为83%的0级和I级病变患者提供良好至极佳的长期（5-8年）结果。50%的II级病变（继发于关节炎的骨赘伴关节间隙狭窄）患者的长期结果为良好/极佳。在后踝撞击中，当踝关节被迫跖屈时，患者会出现后足疼痛。创伤或过度使用可能是原因。创伤机制是过度跖屈或合并内翻跖屈损伤。过度使用损伤通常发生在芭蕾舞者和下坡跑步者中，他们报告距骨后外侧触诊疼痛。平片上可见三角骨或肥大的后突或距骨突。手术治疗包括切除三角骨、瘢痕组织或肥厚的后距突。在合并后方骨撞击和拇长屈肌腱病变的情况下，同时进行拇长屈肌腱松解。内窥镜治疗与低发病率、短恢复时间相关，并且在80%的患者中在2-5年随访时提供良好/极好的结果。
Anterior ankle impingement is characterized by anterior ankle pain on activity. Recurrent (hyper) dorsiflexion is often the cause. Typically, there is pain on palpation at the anteromedial or anterolateral joint line. Some swelling or limitation in dorsiflexion are present. Plain radiographs can disclose the cause of the impingement. In the case of spurs or osteophytes, the diagnosis is anterior bony impingement. In the absence of spurs or osteophytes, the diagnosis is anterior soft tissue impingement. In patients with anteromedial impingement, plain radiographs ae often falsely negative. An oblique view (anteromedial impingement view = AMI view) is recommended in these patients. Arthroscopic management with removal of the offending tissue provides good to excellent long-term (5-8 years) results in 83% of patients with grade 0 and grade I lesions. Long-term results are good/excellent in 50% of patients with grade II lesions (osteophytes secondary to arthritis with joint space narrowing). In posterior ankle impingement, patients experience hindfoot pain when the ankle is forcedly plantarflexed. Trauma or overuse can be the cause. The trauma mechanism is hyperplantarflexion or a combined inversion plantarflexion injury. Overuse injuries typically occur in ballet dancers and downhill runners, who report pain on palpation at the posterolateral aspect of the talus. On plain radiographs, an os trigonum or hypertrophic posterior or talar process can be detected. Surgical management involves removal of the os trigonum, scar tissue, or hypertrophic posterior talar process. In the case of combined posterior bony impingement and flexor hallucis longus tendinopathy, a release of the flexor hallucis longus is performed simultaneously. Endoscopic management is associated with a low morbidity, a short recovery time, and provides good/excellent results at 2-5 years follow-up in 80% of patients.