AANA Fellowship Education - Ankle Arthroscopy, Ankle Instability, Talar OCDs, Achilles Ruptures: What Every Sports Physician Should Know-Presentation (PDF)

Presentation (PDF)

Pdf Summary

This comprehensive webinar, led by Dr. Eric I. Ferkel and colleagues on February 2, 2021, covers critical topics in sports medicine related to ankle arthroscopy, ankle instability, talar osteochondral defects (OCDs), and Achilles tendon ruptures. It provides essential knowledge for sports physicians addressing complex ankle pathologies.

<strong>Ankle Arthroscopy:</strong> Indications include soft tissue and bony impingement, osteochondral lesions of the talus (OLT), fractures, arthrofibrosis, arthrodesis, and lateral ankle instability (focused on the ATFL). Techniques involve anterior and posterior portal setups under specific patient positioning to access ankle and subtalar joints safely, emphasizing understanding anatomy and portal placement to avoid neurovascular injury. Arthroscopic ankle arthrodesis offers decreased morbidity but comes with a learning curve.

<strong>Talar OCDs:</strong> Often occur after ankle sprains, causing deep ankle pain and swelling. Diagnosis combines clinical exam, plain radiographs (often normal), MRI (highly sensitive but may overestimate lesion size), and CT scans. The international consensus supports advanced imaging and recommends conservative treatment for asymptomatic, nondisplaced, or skeletally immature cases. Surgical options focus on bone marrow stimulation (BMS) for lesions up to 10 mm diameter or 100 mm² area, with alternative grafting techniques for larger or cystic lesions. Emerging biologics like BMAC and PRP are under research for enhancing healing.

<strong>Lateral Ankle Instability:</strong> Most ankle sprains involve lateral ligament injury, especially ATFL and CFL ligaments. Acute treatment involves rest, ice, compression, early controlled motion with functional bracing, and physical therapy. Chronic instability may require surgical repair, typically an anatomic Brostrom procedure, which has better return-to-play outcomes than non-anatomic reconstructions. Arthroscopic Brostrom techniques show promising biomechanical equivalence and quicker recovery. Prevention includes bracing and neuromuscular training.

<strong>Achilles Tendon Ruptures:</strong> Surgical repair aims to restore muscle-tendon continuity, reduce rerupture risk, and enable early rehabilitation. Mini-open techniques like PARS offer comparable outcomes to open repair with fewer wound complications and faster recovery. Postoperative protocols emphasize protection against excessive dorsiflexion and progressive rehabilitation, with return to sport typically within 12-16 weeks. Studies in elite athletes, such as NFL players, show good return-to-play rates without increased complications.

The webinar also included detailed case discussions demonstrating diagnosis, imaging, treatment decisions, and surgical techniques, emphasizing thorough arthroscopic evaluation before open procedures for ankle instability and tailored management of OCDs and Achilles ruptures.

Key references and resources support evidence-based practices. The session highlights the importance of combining clinical expertise, advanced imaging, surgical skill, and biologic adjuncts to optimize outcomes in ankle sports injuries.

Keywords

Ankle Arthroscopy

Talar Osteochondral Defects

Achilles Tendon Ruptures

Lateral Ankle Instability

Bone Marrow Stimulation

Arthroscopic Brostrom Procedure

PARS Technique

Sports Medicine

Advanced Imaging

Ankle Sprains