Ankle Arthroscopy versus Conservative Modalities in Management of Ankle Impingement Syndrome: A Systematic Review of Literature

Background: it has been well established that chronic ankle pain negatively affects the lives of patients. Surgical techniques for ankle pain have evolved dramatically over the past decade, as arthroscopic equipment has improved to allow excellent exposure to the ankle joint and surrounding anatomic areas. Soft- tissue and osseous impingement syndromes are now increasingly recognized as a significant cause of chronic ankle pain, The exact cause of this condition is debated but seems to involve osteophyte formation due to either repetitive microtrauma or macrotrauma associated with major injuries. Careful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients. Aim of the work: this systematic review aimed to assess the outcome of ankle arthroscopy versus conservative modalities in management of ankle impingement syndrome. Methods: a systematic literature search of the PubMed, Embase (classic), and Chochrane library databases, for articles that published from January 1990 to June 2017 was performed using the following inclusion criteria English language puplications, human clinical trials, studies that reported on at least one of the chosen outcome measures which are patient satisfaction, time to return to full activity, AOFAS score, visual analog scale (VAS) score for pain, and complications, we found 9 studies met our inclusion criteria, data extraction was done which is consisted of population characteristics, in addition to the outcome measures. Results: nine articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with ankle impingement syndrome, patient satisfaction rates was reported in 5 studies, we reported high percentages of good to excellent satisfaction rates, ranging 74% to 94%, especially in patients treated with arthroscopy, Complication rates were 14.1%, as regard to patients treated with arthroscopy the rate was 13.2%, on the other hand the rate was 17.6% in those patients treated with injection therapy technique, conventional conservative modalities reported to be ineffective in treating ankle impingement except injection therapy technique in case of ankle soft tissue impingement. Conclusion: our systematic review showed that Patients may respond to conservative treatment modalities, especially ultra-sound guided injection mainly in soft tissue impingement type, arthroscopic debridement is the treatment of choice for patients of ankle impingement syndrome of both osseous and soft tissue nature with least morbidity and early return to function, and also it is noted to be superior to conservative modalities.