Rietveld A B M Boni, Hagemans F M T, Haitjema S, Vissers T, Nelissen R G H H
Medical Center for Dancers and Musicians, MC Haaglanden, Medical Centre for Dancers and Musicians (MCDM), The Hague Medical Centre, Postbox 432, 2501 CK The Hague, The Netherlands;, Email:
Medical Center for Dancers and Musicians, MC Haaglanden, The Hague, The Netherlands.
J Dance Med Sci. 2018 Mar 15;22(1):19-32. doi: 10.12678/1089-313X.22.1.19.
Dancing on pointe and relevé requires extreme plantar flexion of the talo-crural joint. Hence, these positions may lead to posterior ankle impingement syndrome (PAIS). PAIS often coincides with flexor hallucis longus tendinopathy (FHL tendinopathy, or "dancers' tendinitis"). Both injuries can appear in isolation as well. The goal of this review is to evaluate the results and the available levels of evidence of conservative and operative treatment (both open and endoscopic) of PAIS and FHL tendinopathy in dancers. It also offers an insight into the history of dance medical publications on this subject. In October 2016, a systematic search of PubMed, Embase, Cochrane, CINAHL, Web of Science, and (in French) ScienceDirect databases was undertaken. Five hundred and seventy-six publications were found, of which a total of 27 reported the results of operative treatment in 376 ankles (344 open, 32 endoscopic) in 324 dancers. The outcome was good to excellent in most cases (89%). The mean period of return to dance for all surgeries combined (PAIS and FHL tendinopathy, open and endo) was 11 weeks (range: 4 to 36 weeks), and for isolated FHL tendinopathy 16 weeks (range: 8 to 36 weeks). Only six publications reported the results of conservative treatment in 33 ankles (13 PAIS, 20 FHL tendinopathy) of 28 dancers, which does not allow for any evidence-based recommendations. Most studies failed to include dance-specific baseline characteristics, like dance style and level of participation. We concluded that only retrospective studies with levels of evidence four and five show that operative treatment for PAIS and FHL tendinopathy is successful with few complications. Since isolated PAIS, PAIS combined with FHL tendinopathy, and isolated FHL injuries appear to be different pathological entities, more research taking into account demography, dance type, and level of participation is needed to find out in which cases early operative management should be considered or avoided. The same applies to defining the place of endoscopic surgery in dancers and being able better to predict which pathology is likely to produce worse outcomes or delay the return to dance. Future research should have a prospective design, including dance-specific outcome scores both preand post-treatment. Furthermore, preferably a prospective randomized controlled design should be used to compare different conservative and operative treatment options.
踮脚尖跳舞和单脚站立需要距小腿关节极度跖屈。因此，这些姿势可能会导致后踝撞击综合征（PAIS）。PAIS常与拇长屈肌腱病（FHL肌腱病，即“舞者肌腱炎”）同时出现。这两种损伤也可能单独出现。本综述的目的是评估舞蹈演员PAIS和FHL肌腱病的保守治疗及手术治疗（开放手术和内镜手术）的结果及现有证据水平。它还深入探讨了关于该主题的舞蹈医学出版物的历史。2016年10月，对PubMed、Embase、Cochrane、CINAHL、科学网以及（法语的）科学Direct数据库进行了系统检索。共找到576篇出版物，其中27篇报告了324名舞蹈演员376个踝关节（344个开放手术，32个内镜手术）的手术治疗结果。大多数病例的结果为良好至优秀（89%）。所有手术（PAIS和FHL肌腱病，开放手术和内镜手术）的平均重返舞蹈时间为11周（范围：4至36周），孤立性FHL肌腱病的平均重返舞蹈时间为16周（范围：8至36周）。只有6篇出版物报告了28名舞蹈演员33个踝关节（13个PAIS，20个FHL肌腱病）的保守治疗结果，这无法得出任何基于证据的建议。大多数研究未纳入特定于舞蹈的基线特征，如舞蹈风格和参与水平。我们得出结论，只有证据水平为四和五的回顾性研究表明，PAIS和FHL肌腱病的手术治疗是成功的，并发症较少。由于孤立性PAIS、PAIS合并FHL肌腱病以及孤立性FHL损伤似乎是不同的病理实体，需要更多考虑人口统计学、舞蹈类型和参与水平的研究，以确定在哪些情况下应考虑或避免早期手术治疗。这同样适用于确定内镜手术在舞蹈演员中的地位，以及更好地预测哪种病理可能产生更差的结果或延迟重返舞蹈。未来的研究应采用前瞻性设计，包括治疗前后特定于舞蹈的结果评分。此外，最好采用前瞻性随机对照设计来比较不同的保守治疗和手术治疗方案。
