Description of patient (type of occupation, indication of age, intensity of sport):
19 Y.O Basketball player with history of 2 years of recurrent ankle sprains. Main complaints are of medial side pain even while walking.
History and previous treatment:
Patient was treated with physio and braces with no improvement.
Current complaints:
Medial ankle pain.
Physical examination:
Tenderness of anteromedial and posteromedial of the ankle. Positive posterior impingment sign. No tenderness over FHL and with repeated motion of MTP.
Radiology:
X-ray:
Medial osteophyte on tibia and Talus. Os trigonum.
Additional investigation (CT/MRI):
CT same as above and free body posteriorly at level of subtalar joint.
I performed an anterior arthroscopy with removal of osteophytes. My initial plan was to then turn the patient to the prone position and perform Hindfoot arthroscopy but the ankle was swollen and filled with blood from resected bone. I performed an open removal of Ostrigonum and free body.
Case summary:
Combined AMI and Posterior impingement
Question(s) to this case:
In cases of combined need for anterior and posterior arthroscopy would you go first back than front or vise versa? Would you recommand doing it at separate occasions?
Expert:
I first go to the back to perform 2 portal hindfoot aproach. Then turn the patient and perform 2 portal anterior arthroscopy. Make sure the patients leg is slightly off the table (folded sterile blanket under the lower leg) in order to have the 2 wounds not rubbing on the table. Wounds must be free and not rub on the table in order to prevent infection. For preoperative planning in this anteromedial impingementit is important to make an anteromedial impingement view (AMI-view). You can find a 3D animation of the AMI view in the technique on anterior bony impingement (surgical technique section)